Form 79-019A Application to Operate an Inedible Kitchen Grease Rendering Plant - California

Form 79-019A is a California Department of Food & Agriculture form also known as the "Application To Operate An Inedible Kitchen Grease Rendering Plant". The latest edition of the form was released in August 1, 2018 and is available for digital filing.

Download a PDF version of the Form 79-019A 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
Date:
Meat, Poultry and Egg Safety Branch
1220 N Street
License Fee: $100.00
Sacramento, CA 95814
Enforcement Fee: $7,000.00
(916) 900-5004
79-019A (Rev. 08/18)
APPLICATION TO OPERATE AN
INEDIBLE KITCHEN GREASE RENDERING PLANT
FEE $7,100.00
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 an Inedible Kitchen Grease Rendering Plant.
Please Print or Type
(If more space is required, please use the back of this form)
Name of Business:
Phone Number:
FAX Number:
Mailing Address:
Location (if different):
City, State, Zipcode:
City, County, Zipcode:
Contact E-mail:
Name and addresses of Owners or Corporate Officers and Managers
Name:
Name:
Address:
Address:
Provide detailed description of proposed business activities:
Describe product(s) to be produced and intended use of product(s), such as for biofuel, animal feed, etc..
(CCR Section 1180.34. For production of products used in animal feed and other agricultural uses, each renderer shall employ a written and
:
verifiable process that results in products that are free of microorganisms that are pathogenic to humans or animals.)
*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.
*Changes may be mailed to the address shown below, or faxed to (916) 900-5334.
*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:
Mail application and $7,100.00 fee to: Department of Food and Agriculture, 1220 N Street, Sacramento, CA 95814.
Please make check payable to: CDFA L 90101
STATE OF CALIFORNIA
DEPARTMENT OF FOOD AND AGRICULTURE
Date:
Meat, Poultry and Egg Safety Branch
1220 N Street
License Fee: $100.00
Sacramento, CA 95814
Enforcement Fee: $7,000.00
(916) 900-5004
79-019A (Rev. 08/18)
APPLICATION TO OPERATE AN
INEDIBLE KITCHEN GREASE RENDERING PLANT
FEE $7,100.00
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 an Inedible Kitchen Grease Rendering Plant.
Please Print or Type
(If more space is required, please use the back of this form)
Name of Business:
Phone Number:
FAX Number:
Mailing Address:
Location (if different):
City, State, Zipcode:
City, County, Zipcode:
Contact E-mail:
Name and addresses of Owners or Corporate Officers and Managers
Name:
Name:
Address:
Address:
Provide detailed description of proposed business activities:
Describe product(s) to be produced and intended use of product(s), such as for biofuel, animal feed, etc..
(CCR Section 1180.34. For production of products used in animal feed and other agricultural uses, each renderer shall employ a written and
:
verifiable process that results in products that are free of microorganisms that are pathogenic to humans or animals.)
*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.
*Changes may be mailed to the address shown below, or faxed to (916) 900-5334.
*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:
Mail application and $7,100.00 fee to: Department of Food and Agriculture, 1220 N Street, Sacramento, CA 95814.
Please make check payable to: CDFA L 90101

Download Form 79-019A Application to Operate an Inedible Kitchen Grease Rendering Plant - California

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