Get California Fertilizer License Form

07/13 DO YOU HAVE A FERTILIZING MATERIALS LICENSE YES NO If no submit a Fertilizing Materials License Application DOING BUSINESS AS NAME ON LICENSE AND AS APPEARS ON LABEL PHONE NUMBER FULL NAME OF APPLICANT OWNER OR OWNERS FAX NUMBER EMAIL ADDRESS LICENSED ADDRESS AS IT APPEARS ON LABEL STREET NUMBER CITY OR TOWN COUNTY STATE ZIP CODE 4 TYPE OF FERTILIZING MATERIALS CHECK ALL THAT MAY APPLY AUXILIARY SOIL AND PLANT SUBSTANCE PACKAGED SOIL AMENDMENT PACKAGED AGRICULTURAL MINERAL SPECIALTY FERTILIZER NOT SURE IF APPLICABLE PLEASE SUBMIT THE FOLLOWING DOCUMENTATION ORGANIC CERTIFICATION MICROBIAL LABORATORY ANALYSIS AND METHOD HEAVY METALS DATA REFER TO SECTION 2303 S OF THE CALIFORNIA CODE OF REGULATIONS FOR THE REQUIRED METALS. STATE OF CALIFORNIA FERTILIZING MATERIALS REGISTRATION APPLICATION DEPARTMENT OF FOOD AND AGRICULTURE FEED FERTILIZER LIVESTOCK DRUGS REGULATORY SERVICES 513-026 REV. FAILURE TO SUBMIT THE REQUIRED DOCUMENTATION MAY RESULT IN A DELAY OF PROCESSING YOUR APPLICATION* PLEASE SUBMIT ONE 8 X 11 COPY OF LABELING - LARGER SIZES ARE UNACCEPTABLE* LABELING MEANS ALL WRITTEN PRINTED OR GRAPHIC MATTER ON ACCOMPANYING OR USED IN PROMOTING SALE OF ANY FERTILIZING MATERIAL INCLUDING ADVERTISEMENTS BROCHURES POSTERS AND TELEVISION AND RADIO ANNOUNCEMENTS* REFER TO SECTION 14542 OF THE FOOD AND AGRICULTURAL CODE* I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT. The Department of Food and Agriculture has established time periods for the processing of permit applications in compliance with Government Code Sections 1537415378. Failure to comply with these time periods may be appealed to the Secretary of Food and Agriculture P. O. Box 942871 Sacramento CA 94271-0001 pursuant to regulations set forth in Title 3 California Code of Regulations Section 301. Under certain circumstances the Secretary may order that the applicant receive a reimbursement of filing fees. SIGNATURE OF AUTHORIZED REPRESENTATIVE TYPE OR PRINT NAME DATE THE FEE FOR A FERTILIZING MATERIALS LABEL REGISTRATION IS ONE HUNDRED DOLLARS 100 PER PRODUCT. THE REGISTRATION EXPIRES ON DECEMBER 31 OF AN ODD-NUMBERED YEAR* THE ABOVE FEE IS A LABEL REVIEW FEE AND IS NOT REFUNDABLE* SEND ONE COPY OF THIS APPLICATION WITH ONE 8 X 11 COPY OF LABELING AND FEES TO CASHIER CFI CALIFORNIA DEPARTMENT OF FOOD AGRICULTURE P. O. BOX 942872 SACRAMENTO CA 94271-2872 DEPT. USE ONLY RC NO. AND DATE FEE PENALTY DO NOT SEND COIN OR CURRENCY Page 1 of 2 PLEASE FILL OUT ALL FIELDS* INCOMPLETE APPLICATIONS CANNOT BE PROCESSED AND WILL BE RETURNED. FAILURE TO SUBMIT THE REQUIRED DOCUMENTATION MAY RESULT IN A DELAY OF PROCESSING YOUR APPLICATION* PLEASE SUBMIT ONE 8 X 11 COPY OF LABELING - LARGER SIZES ARE UNACCEPTABLE* LABELING MEANS ALL WRITTEN PRINTED OR GRAPHIC MATTER ON ACCOMPANYING OR USED IN PROMOTING SALE OF ANY FERTILIZING MATERIAL INCLUDING ADVERTISEMENTS BROCHURES POSTERS AND TELEVISION AND RADIO ANNOUNCEMENTS* REFER TO SECTION 14542 OF THE FOOD AND AGRICULTURAL CODE* I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT. The Department of Food and Agriculture has established time periods for the processing of permit applications in compliance with Government Code Sections 1537415378.