Form 79-006A "Application to Operate a Collection Center" - California

What Is Form 79-006A?

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 August 1, 2018;
  • 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 79-006A 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 79-006A "Application to Operate a Collection Center" - California

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STATE+A1:BH53 OF CALIFORNIA
DEPARTMENT OF FOOD AND AGRICULTURE
Office Use Only
Establishment Number:
Meat, Poultry and Egg Safety Branch
Date:
1220 N Street
License Fee: $100.00
Sacramento, CA 95814
Enforcement Fee: $3,500.00 PLUS
(916) 900-5004
$500.00 per truck up to a maximum
79-006A (Rev. 08/18)
of $7,000.00 per plant per year
APPLICATION TO OPERATE A COLLECTION CENTER
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 Collection Center.
Inedible Kitchen Grease
Animal Material
Please Print or Type
(If more space is required, please use the back of this form)
Name of Business:
Phone Number:
FAX:
Mailing Address:
Location (if different):
City, State, Zipcode:
City, County, Zipcode:
Name of Contact Person:
Contact Person E-Mail Address:
Name and address of Owners or Corporate Officers and Managers
Name:
Name :
Address:
Address:
Name and Location of Renderer or Pet Food Processor through which denatured, inedible and/or condemned material
is to be disposed
Name:
Name:
Address:
Address:
Type of Business:
Type of Business:
Yes
No
Skinning, eviscerating, or cutting up carcasses will be conducted at this facility.
If yes, state the rendering facility where skinned material will be transported.
*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.
Printed Name of Applicant:
Signature of Applicant:
Mail application and fee to: Department of Food and Agriculture, 1220 N Street, Sacramento, CA 95814.
Please make check payable to: CDFA L 90101
STATE+A1:BH53 OF CALIFORNIA
DEPARTMENT OF FOOD AND AGRICULTURE
Office Use Only
Establishment Number:
Meat, Poultry and Egg Safety Branch
Date:
1220 N Street
License Fee: $100.00
Sacramento, CA 95814
Enforcement Fee: $3,500.00 PLUS
(916) 900-5004
$500.00 per truck up to a maximum
79-006A (Rev. 08/18)
of $7,000.00 per plant per year
APPLICATION TO OPERATE A COLLECTION CENTER
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 Collection Center.
Inedible Kitchen Grease
Animal Material
Please Print or Type
(If more space is required, please use the back of this form)
Name of Business:
Phone Number:
FAX:
Mailing Address:
Location (if different):
City, State, Zipcode:
City, County, Zipcode:
Name of Contact Person:
Contact Person E-Mail Address:
Name and address of Owners or Corporate Officers and Managers
Name:
Name :
Address:
Address:
Name and Location of Renderer or Pet Food Processor through which denatured, inedible and/or condemned material
is to be disposed
Name:
Name:
Address:
Address:
Type of Business:
Type of Business:
Yes
No
Skinning, eviscerating, or cutting up carcasses will be conducted at this facility.
If yes, state the rendering facility where skinned material will be transported.
*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.
Printed Name of Applicant:
Signature of Applicant:
Mail application and fee to: Department of Food and Agriculture, 1220 N Street, Sacramento, CA 95814.
Please make check payable to: CDFA L 90101