
ORGANIC INPUT MATERIAL
STATE OF CALIFORNIA
FERTILIZING MATERIALS REGISTRATION APPLICATION DEPARTMENT OF FOOD AND AGRICULTURE
513-026 (REV. 12/10) FEED, FERTILIZER, LIVESTOCK DRUGS, & EGG REGULATORY SERVICES
Page 1 of 2
PLEASE FILL OUT ALL FIELDS. INCOMPLETE APPLICATIONS CANNOT BE PROCESSED
AND WILL BE RETURNED.
DO YOU HA
VE 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) (FAX NUMBER)
FULL NAME OF APPLICANT (OWNER OR OWNERS): EMAIL :
ADDRESS (LICENSED ADDRESS AS IT APPEARS ON LABEL) :
(STREET NUMBER) (CITY OR TOWN) (COUNTY) (STATE) (ZIP CODE +4)
TYPE OF ORGANIC INPUT MATERIAL (CHECK ALL THAT MAY APPLY):
□ AUXILIARY SOIL AND PLANT SUBSTANCE
□ AGRICULTURAL MINERAL
□ COMMERCIAL FERTILIZER
□ SOIL AMENDMENT
□ SPECIALTY FERTILIZER
□ NOT SURE
PLEASE SUBMIT THE FOLLOWING DOCUMENTATION: COMPLETE FORMULA OF MATERIAL, COMPLETE DESCRIPTION OF THE
MANUFACTURING PROCESS FOR EACH INGREDIENT AND THE FINAL PRODUCT, INTENDED USE OF PRODUCT, SUPPLIER OF
INGREDIENTS, ALTERNATE FORMULATION, THIRD PARTY FORMULATED INGREDIENTS, AND ANY ADDITIONAL INFORMATION
SUPPORTING COMPLIANCE WITH THE NATIONAL ORGANIC PROGRAM STANDARDS. FAILURE TO SUBMIT THE REQUIRED
DOCUMENTATION MAY RESULT IN A DELAY OF PROCESSING YOUR APPLICATION.
PLEASE SUBMIT ONE 8 ½ 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.
SIGNATURE OF AUTHORIZED REPRESENTATIVE
The Department of Food and Agriculture has established
time periods for the processing of permit applications, in
compliance with Government Code Sections 15374-
15378. 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.
TYPE OR PRINT NAME
DATE
DEPT. USE ONLY
RC NO. AND DATE
FEE
PENALTY
THE FEE FOR AN ORGANIC INPUT MATERIAL LABEL REGISTRATION IS FIVE
HUNDRED DOLLARS ($500) 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 ½ X 11 COPY OF LABELING
AND FEES TO:
CASHIER, CFI
CALIFORNIA DEPARTMENT OF FOOD & AGRICULTURE
P.O. BOX 942872
SACRAMENTO, CA 94271-2872
DO NOT SEND COIN OR CURRENCY