Additional Health Department Forms

Forms for Food & Drug Safety Program

Forms and Instructions
Form # Form Name/Title Linked File Instruction/ Comments
F-2 Registration of Drug or Medical Device Manufacturing or Wholesale Drug or Medical Device Business
(Updated May 23, 2022)
pdf (505k)
 
F-5 Bulk and Bottled Water Establishment Application
(Updated June 29th, 2022)
F-5 (1219k)
 
F-8 Initial Application for License to Operate a Refrigerated Warehouse and/or Locker Plant
pdf (14k)
doc (33k)
 
F-9 Initial Application for License to Operate a Non-Alcoholic Beverage Manufacturing Plant
pdf (12k)
doc (33k)
 
F-12 Application for Certificate of Free Sale (CFS)
(Updated September 15th, 2023)
F-12 (845k)
Guidelines for Requesting Certificates of Free Sale (Updated November, 2016)
 
F-13 Renewal or Discontinuation Application to Operate a Wholesale Drug or Medical Device Business
(Updated September 11th, 2023)
F-13 (507k)
 
F-17 Application for Permit to Handle Nitrous Oxide
(Updated June 23rd, 2022)
pdf (231k)
 
F-19 Renewal Application to Operate a Refrigerated Warehouse-Locker Plant
(Updated April 26th, 2022)
F-19 (167k)
 
F-26 Self-Inspection Checklist (Wholesale)
pdf (23k)
doc (86k)
 
F-27 Self-Inspection Checklist (Retail)
pdf (21k)
doc (74k)
 
F-29 Initial Application for License to Operate a Wholesale Food-Cosmetic Establishment
pdf (30k)
doc (66k)
 
F-30 Satisfactory Placard
pdf (26k)
doc (246k)
Note  
F-31 Unsatisfactory Placard
pdf (26k)
doc (245k)
Note
 
F-32 Conditionally Satisfactory Placard
pdf (26k)
doc (247k)
Note  
F-33 Sanitary Inspection Report
pdf (22k)
doc (253k)
Note
 
F-35 Retail Food Inspection Report (Local Health Departments)
pdf (33k)
doc (112k)
Note  
F-37 Risk-Based Inspection Report (Local Health Departments)
pdf (27k)
doc (115k)
Note
 
F-39 Renewal Application to Operate a Non-Alcoholic Beverage and/or Bottling Plant
(Updated April 26th, 2022)
F-39 (173k)
 
F-41 Renewal Application to Operate a Wholesale Food/Cosmetic Establishment
(Updated June 5th, 2023)
F-41 (179k)
New fillable PDF form!
Word document no longer available.
 
F-42 Renewal Application for Certification to Sell Bottled Water or Bulk Water
(Replaced by revised F-5 form on June 16th, 2022)
 
F-48 Application for Certification to Handle Oysters, Clams or Mussels
pdf (13k)
doc (38k)
 
F-L3 Certificate of Free Sale Package (English) (including F-L3 and F-12 Forms)
(Updated September 15th, 2023)
F-L3 (866k)
Guidelines for Requesting Certificates of Free Sale (Updated November, 2016)  
F-L4 Certificate of Free Sale Package (Spanish) (including F-L4 and F-12 Forms)
(Updated September 15th, 2023)
F-L4 (866k)
Guidelines for Requesting Certificates of Free Sale (Updated November, 2016)
 
M-3 Application for a Milk Plant or a Bulk Milk Hauler (BTU) Permit
(Updated June 16th, 2022)
pdf (1035k)
 
M-5 License to Manufacture Frozen Desserts Establishment Application
(Updated June 16th, 2022)
pdf (331k)
 
M-6 Renewal Application to Operate a Frozen Dessert Plant
(Replaced by revised M-5 form on June 16th, 2022)
 
M-7 Application for Temporary Marketing Permit:
Frozen Desserts Manufacturing Plant
pdf (11k)
doc (36k)
 
M-8 Renewal Application to Operate a Bulk Tank Unit/Milk Plant
(Replaced by revised M-3 form on June 16th, 2022)
 
MS-5 Continuation Sheet
pdf (10k)
doc (36k)
 
Wholesale Food/Cosmetic Establishments
Form # Form Name/Title Linked File Instruction/ Comments
F-29 Initial Application for License to Operate a Wholesale Food-Cosmetic Establishment
pdf (30k)
doc (66k)
 
F-41 Renewal Application to Operate a Wholesale Food/Cosmetic Establishment
(Updated June 5th, 2023)
F-41 (179k)
New fillable PDF form!
Word document no longer available.  
Milk Plants/Bulk Milk Hauler
Form # Form Name/Title Linked File Instruction/ Comments
M-3 Application for a Milk Plant or a Bulk Milk Hauler (BTU) Permit
(Updated June 16th, 2022)
pdf (1035k)
 
M-8 Renewal Application to Operate a Bulk Tank Unit/Milk Plant
(Replaced by revised M-3 form on June 16th, 2022)
 
Frozen Dessert Plants
Form # Form Name/Title Linked File Instruction/ Comments
M-5 License to Manufacture Frozen Desserts Establishment Application
(Updated June 16th, 2022)
pdf (331k)
 
M-6 Renewal Application to Operate a Frozen Dessert Plant
(Replaced by revised M-5 form on June 16th, 2022)
 
M-7 Application for Temporary Marketing Permit:
Frozen Desserts Manufacturing Plant
pdf (11k)
doc (36k)
 
Bottled Water Registration
Form # Form Name/Title Linked File Instruction/ Comments
F-5 Bulk and Bottled Water Establishment Application
(Updated June 29th, 2022)
F-5 (1219k)
 
F-42 Renewal Application for Certification to Sell Bottled Water or Bulk Water
(Replaced by revised F-5 form on June 16th, 2022)
 
Shellfish Certification
Form # Form Name/Title Linked File Instruction/ Comments
F-48 Application for Certification to Handle Oysters, Clams or Mussels
pdf (13k)
doc (38k)
 
Non Alcoholic Beverage Establishments
Form # Form Name/Title Linked File Instruction/ Comments
F-9 Initial Application for License to Operate a Non-Alcoholic Beverage Manufacturing Plant
pdf (12k)
doc (33k)
 
F-39 Renewal Application to Operate a Non-Alcoholic Beverage and/or Bottling Plant
(Updated April 26th, 2022)
F-39 (173k)
 
Refrigerated Warehouse
Form # Form Name/Title Linked File Instruction/ Comments
F-8 Initial Application for License to Operate a Refrigerated Warehouse and/or Locker Plant
pdf (14k)
doc (33k)
 
F-19 Renewal Application to Operate a Refrigerated Warehouse-Locker Plant
(Updated April 26th, 2022)
F-19 (167k)
 
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