Form 79-015 Driver/Vehicle Information for Renderers - California

Form 79-015 is a California Department of Food & Agriculture form also known as the "Driver/vehicle Information For Renderers". The latest edition of the form was released in April 1, 2018 and is available for digital filing.

Download a PDF version of the Form 79-015 down below or find it on California Department of Food & Agriculture Forms website.

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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
79-015 (Rev. 04/18)
Date
DRIVER/VEHICLE INFORMATION FOR RENDERERS
Please Print or Type
Name of Business
Phone Number
FAX Number
Mailing Address
Location (if different)
City, State, Zipcode
City, County, Zipcode
Contact Person(s) - Please Print or Type
Use Additional Sheets if Necessary to Answer the Following Information:
Drivers' Name
Drivers' License Number
Drivers' Name
Drivers' License Number
LICENSE PLATE NUMBERS OF VEHICLES
Any change in the information contained in the license or registration application shall be reported in writing to the
Meat, Poultry and Egg Safety Branch within (10) business days of such change.
*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.
*Providing false information on applications for licenses or registration application shall be a violation and shall be
justification for denial of an application.
*I declare under penalty of perjury that the information provided on this application is true and accurate to the best of
my knowledge.
Printed Name of Applicant
Signature of Applicant
Title
STATE OF CALIFORNIA
DEPARTMENT OF FOOD AND AGRICULTURE
Meat, Poultry and Egg Safety Branch
1220 N Street
Sacramento, CA 95814
(916) 900-5004
79-015 (Rev. 04/18)
Date
DRIVER/VEHICLE INFORMATION FOR RENDERERS
Please Print or Type
Name of Business
Phone Number
FAX Number
Mailing Address
Location (if different)
City, State, Zipcode
City, County, Zipcode
Contact Person(s) - Please Print or Type
Use Additional Sheets if Necessary to Answer the Following Information:
Drivers' Name
Drivers' License Number
Drivers' Name
Drivers' License Number
LICENSE PLATE NUMBERS OF VEHICLES
Any change in the information contained in the license or registration application shall be reported in writing to the
Meat, Poultry and Egg Safety Branch within (10) business days of such change.
*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.
*Providing false information on applications for licenses or registration application shall be a violation and shall be
justification for denial of an application.
*I declare under penalty of perjury that the information provided on this application is true and accurate to the best of
my knowledge.
Printed Name of Applicant
Signature of Applicant
Title

Download Form 79-015 Driver/Vehicle Information for Renderers - California

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