Form FDACS-05060 "Application for a Bulk Milk Hauler/Sampler Permit" - Florida

What Is Form FDACS-05060?

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

Form Details:

  • Released on October 1, 2007;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form FDACS-05060 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-05060 "Application for a Bulk Milk Hauler/Sampler Permit" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Food Safety
Bureau of Dairy Industry
Submit completed application to:
Florida Department of Agriculture and
APPLICATION FOR A
Consumer Services
BULK MILK HAULER/SAMPLER PERMIT
Bureau of Dairy Industry
NICOLE "NIKKI" FRIED
3125 Conner Boulevard, Mail Stop C-18
COMMISSIONER
Section 502.053, Florida Statutes
Tallahassee, Florida 32399-1650
Hauler.Tanker@FDACS.gov
(850) 245-5410 – Phone
(850) 488-7946 – FAX
Note: All documents and attachments submitted with this request are subject to public review pursuant to Chapter 119, F.S.
Pursuant to the requirement of the Milk, Milk Products and Frozen Desserts Law, Chapter 502, Florida Statutes and
Chapter 5D-1, Florida Administrative Code, I hereby make application for a state permit as a:
BULK MILK HAULER/SAMPLER
NEW HAULER
PERMIT RENEWAL
DATE:
APPLICANT’S NAME:
PERMIT NUMBER (if renewing):
HOME ADDRESS (street or P.O. Box):
CITY, STATE & ZIP:
HOME PHONE NUMBER:
APPLICANT’S TERMINAL OR BASE OF OPERATION:
HAULER EXAM INFORMATION (NEW HAULERS)
HAULER’S EXAM SCORE:
DATE OF EXAM:
EXAM ADMINISTERED BY:
HAULING SERVICE INFORMATION
APPLICANT EMPLOYED BY:
NAME OF PERSON SUBMITTING APPLICATION:
PHONE NUMBER:
EMAIL ADDRESS
I hereby agree to obey the law and all the rules set forth in Chapter 502, Florida Statutes, governing the transportation and sampling of milk, and will not
tolerate disobedience of the law by anyone in my employ.
I recognize that this permit may be revoked or suspended for cause and agree that, upon revocation of permit or upon ceasing to do business under the
name in which the permit shall be issued, no attempt will be made to use this permit. I will not lend or transfer this permit to any person or firm
whatsoever.
PERMIT NUMBER ISSUED
PLEASE FAX OR MAIL THIS APPLICATION TO ONE OF
To be filled in by FDACS personnel only.
THE ADDRESSES PROVIDED AT THE TOP OF THIS
FORM.
FDACS-05060 Rev. 10/07
Florida Department of Agriculture and Consumer Services
Division of Food Safety
Bureau of Dairy Industry
Submit completed application to:
Florida Department of Agriculture and
APPLICATION FOR A
Consumer Services
BULK MILK HAULER/SAMPLER PERMIT
Bureau of Dairy Industry
NICOLE "NIKKI" FRIED
3125 Conner Boulevard, Mail Stop C-18
COMMISSIONER
Section 502.053, Florida Statutes
Tallahassee, Florida 32399-1650
Hauler.Tanker@FDACS.gov
(850) 245-5410 – Phone
(850) 488-7946 – FAX
Note: All documents and attachments submitted with this request are subject to public review pursuant to Chapter 119, F.S.
Pursuant to the requirement of the Milk, Milk Products and Frozen Desserts Law, Chapter 502, Florida Statutes and
Chapter 5D-1, Florida Administrative Code, I hereby make application for a state permit as a:
BULK MILK HAULER/SAMPLER
NEW HAULER
PERMIT RENEWAL
DATE:
APPLICANT’S NAME:
PERMIT NUMBER (if renewing):
HOME ADDRESS (street or P.O. Box):
CITY, STATE & ZIP:
HOME PHONE NUMBER:
APPLICANT’S TERMINAL OR BASE OF OPERATION:
HAULER EXAM INFORMATION (NEW HAULERS)
HAULER’S EXAM SCORE:
DATE OF EXAM:
EXAM ADMINISTERED BY:
HAULING SERVICE INFORMATION
APPLICANT EMPLOYED BY:
NAME OF PERSON SUBMITTING APPLICATION:
PHONE NUMBER:
EMAIL ADDRESS
I hereby agree to obey the law and all the rules set forth in Chapter 502, Florida Statutes, governing the transportation and sampling of milk, and will not
tolerate disobedience of the law by anyone in my employ.
I recognize that this permit may be revoked or suspended for cause and agree that, upon revocation of permit or upon ceasing to do business under the
name in which the permit shall be issued, no attempt will be made to use this permit. I will not lend or transfer this permit to any person or firm
whatsoever.
PERMIT NUMBER ISSUED
PLEASE FAX OR MAIL THIS APPLICATION TO ONE OF
To be filled in by FDACS personnel only.
THE ADDRESSES PROVIDED AT THE TOP OF THIS
FORM.
FDACS-05060 Rev. 10/07