Form 79-004A "Application to Operate a Pet Food Establishment" - California

What Is Form 79-004A?

This is a legal form that was released by the California Department of Food & Agriculture - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2013;
  • The latest edition provided by the California Department of Food & Agriculture;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 79-004A by clicking the link below or browse more documents and templates provided by the California Department of Food & Agriculture.

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Download Form 79-004A "Application to Operate a Pet Food Establishment" - California

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STATE OF CALIFORNIA
DEPARTMENT OF FOOD AND AGRICULTURE
Meat, Poultry and Egg Safety Branch
1220 N Street
Sacramento, CA 95814
(916) 900-5004
79-004A (Rev. 01/13)
Date:
APPLICATION TO OPERATE A PET FOOD ESTABLISHMENT
FEE $100.00
Establishment Number:___________
In accordance with Article 2, Chapter 5, Part 3, Division 9, of the California Food and Agricultural Code, application
is hereby made for a license to operate as a:
PET FOOD SLAUGHTERER
PET FOOD IMPORTER
PET FOOD PROCESSOR
Please Print or Type:
Name of Business:
Phone Number:
Mailing Address:
FAX Number:
Location, if different, and County:
Name and Address of Owners or Corporate Officers and Managers:
Name of Contact Person:
Contact Person E-mail Address:
Experience in the business under which license application is made:
List interest or control you have in any Dead Animal Hauler, Rendering Plant or Collection Center:
Any changes in the information given must be reported to the Meat, Poultry and Egg Safety Branch within 15 days.
Obtaining all information requested is mandatory and required before a license can be issued according to
requirements in Division 9 of the California Food and Agricultural Code.
Mail application and One-Hundred dollar ($100.00) fee to: Cashier, Department of Food and Agriculture,
1220 N Street, Sacramento, CA 95814. You may retain a copy for your records.
Printed Name of Applicant:
Signature of Applicant:
STATE OF CALIFORNIA
DEPARTMENT OF FOOD AND AGRICULTURE
Meat, Poultry and Egg Safety Branch
1220 N Street
Sacramento, CA 95814
(916) 900-5004
79-004A (Rev. 01/13)
Date:
APPLICATION TO OPERATE A PET FOOD ESTABLISHMENT
FEE $100.00
Establishment Number:___________
In accordance with Article 2, Chapter 5, Part 3, Division 9, of the California Food and Agricultural Code, application
is hereby made for a license to operate as a:
PET FOOD SLAUGHTERER
PET FOOD IMPORTER
PET FOOD PROCESSOR
Please Print or Type:
Name of Business:
Phone Number:
Mailing Address:
FAX Number:
Location, if different, and County:
Name and Address of Owners or Corporate Officers and Managers:
Name of Contact Person:
Contact Person E-mail Address:
Experience in the business under which license application is made:
List interest or control you have in any Dead Animal Hauler, Rendering Plant or Collection Center:
Any changes in the information given must be reported to the Meat, Poultry and Egg Safety Branch within 15 days.
Obtaining all information requested is mandatory and required before a license can be issued according to
requirements in Division 9 of the California Food and Agricultural Code.
Mail application and One-Hundred dollar ($100.00) fee to: Cashier, Department of Food and Agriculture,
1220 N Street, Sacramento, CA 95814. You may retain a copy for your records.
Printed Name of Applicant:
Signature of Applicant: