Cal. Code Regs. Tit. 3, div. 2, ch. 1, art. 10 app A

Current through Register 2024 Notice Reg. No. 24, June 14, 2024

Appendix A

State of California, Department of Food and Agriculture

Milk and Dairy Foods Control Branch, License Section

1220 N Street

Sacramento, CA 95814

(916) 900-5008

Application for

BULK MILK TANKER PERMIT

Annual Inspection Fee is Required For This Permit			Please Print Legibly
New []	Renewal [] image	Permit # __________ (if renewal)
(Please check one)
Date ___________________________				Applicants Phone Number (___) ___________________________
Name of Applicant ________________________________________________________________________
Name of Trucking Company ___________________________________________________________________
Name of Owner ____________________________________________________________________________
Business Address __________________________________________________________________________
		Number	Street		City		Zip Code
Mailing Address __________________________________________________________________________
		Number	Street		City		Zip Code
Applicants Signature ________________________________________________________________________

Please mail application to the above address.

___________________________

For Official Use Only

Date of Inspection ___________________________
Tanker Does Not Meet Criteria For Permit []
Tanker Meets Criteria For Permit []		Tanker Permit No. ___________________________
___________________________				___________________________
Dairy Foods Specialist's Signature					Date
Amount Received $ ___________________________					RC Number ___________________________
72-273 (Rev. 11/11)

Cal. Code Regs. Tit. 3, div. 2, ch. 1, art. 10 app A