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*POSITION HELD AT PLANT LOCATION
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Under 18 U.S.C. 1001, anyone who makes a materially false, fictitious, or fraudulent statement to the
U.S. Government is subject to criminal penalties.
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*ADDRESS LINE1
ADDRESS LINE2
*ZIP CODE
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*TELEPHONE
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Code
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Fax Number
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Under 18 U.S.C. 1001, anyone who makes a materially false, fictitious, or fraudulent statement to the
U.S. Government is subject to criminal penalties.
SAME AS PLANT LOCATION
*ESTABLISHMENT NAME
*COUNTRY/AREA
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Country
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*ADDRESS LINE1
ADDRESS LINE2
*ZIP CODE
*CITY
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Numbers only. No spaces, dashes or parentheses. Country Code not
required for US phone numbers.
Country
Code
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(e.g.033)
(e.g.101)
(e.g.5551111)
(e.g.1111)
*TELEPHONE
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Country
Code
Area/City
Code
Fax Number
(e.g.033)
(e.g.101)
(e.g.5551111)
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Under 18 U.S.C. 1001, anyone who makes a materially false, fictitious, or fraudulent statement to the
U.S. Government is subject to criminal penalties.
(Do not list meat and poultry foods under the jurisdiction of the Food Safety and Inspection Service of
the U.S. Department of Agriculture. Listing products processed at this location to obtain an FCE number
does not constitute filing individual processes.)
Food Product Name, Form or Style, and Packing Medium
Low-Acid
Acidified
Please Click Add Product button to add products.
Subject to the terms of 21 CFR 108.25(c)(1) and (2) and 108.35(c)(1) and (2), no commercial processor
shall engage in the processing of low-acid or acidified foods until the completed forms FDA 2541 and
2541a or 2541c have been filed with the FDA within the applicable time frames specified in these
regulations.
Under 18 U.S.C. 1001, anyone who makes a materially false, fictitious, or fraudulent statement to the
U.S. Government is subject to criminal penalties.
Food Product Name, Form or Style, and Packing Medium
LOW-ACID
ACIDIFIED
Under 18 U.S.C. 1001, anyone who makes a materially false, fictitious, or fraudulent statement to the
U.S. Government is subject to criminal penalties.
*CONTACT NAME
*COUNTRY/AREA
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*ADDRESS LINE1
ADDRESS LINE2
*ZIP CODE
*CITY
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*STATE/PROVINCE/TERRITORY
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Numbers only. No spaces, dashes or parentheses. Country Code not
required for US phone numbers.
Country
Code
Area/City
Code
Phone Number
Extension
(e.g.033)
(e.g.101)
(e.g.5551111)
(e.g.1111)
*TELEPHONE
NUMBER
*EMAIL ADDRESS
The undersigned verifies that the products that are the subject of this application are not adulterated or
misbranded and meet the other requirements of the FD&C Act for marketing in the U.S. or cannot be
lawfully marketed in the U.S. but meet the requirements of section 801(e) of the FD&C Act. Further the
requester hereby presents and acknowledges that the company is aware that in making this request the
company is subject to the terms and provisions of Title 18, Section 1001, United States Code which
makes it a criminal offense to falsify, conceal, or cover up a material fact; make any material false,
fictitious, or fraudulent statement or representation; or make or use any false writing or document
knowing the same to contain any materially false, fictitious, or fraudulent statement or entry.
I Agree.
Please review your Registration. If all information is correct, click the Submit button below. To make changes to a
section, click the Edit button for that section. Until you select Submit, the registration process is incomplete and an
FCE number will not be issued.
Date: 01/19/2012 17:32:51
Created Date: 01/19/2012 17:32:51
INITIAL REGISTRATION
FFRM REGISTRATION NUMBER:
REGISTRATION FEI NUMBER:
POSITION HELD AT PLANT LOCATION: Director
ESTABLISHMENT NAME: Test Facility
ADDRESS LINE1: 123 Main Street
ADDRESS LINE2: 300
CITY: Rockville
STATE/PROVINCE/TERRITORY: Maryland
ZIP CODE: 20852
COUNTRY/AREA: UNITED STATES
TELEPHONE NUMBER: 1 301 1212121
TELEFAX NUMBER: 1 301 1212122
✔
SAME AS PLANT LOCATION
ESTABLISHMENT NAME: Test Facility
ADDRESS LINE1: 123 Main Street
ADDRESS LINE2: 300
CITY: Rockville
STATE/PROVINCE/TERRITORY: Maryland
ZIP CODE: 20852
COUNTRY/AREA: UNITED STATES
TELEPHONE NUMBER: 1 301 1212121
TELEFAX NUMBER: 1 301 1212122
(Do not list meat and poultry foods under the jurisdiction of the Food Safety and Inspection Service of the
U.S. Department of Agriculture. Listing products processed at this location to obtain an FCE number does
not constitute filing individual processes.)
Food Product Name, Form or Style, and Packing Medium
Green Bean, Frozen, Tin
Low-Acid
Acidified
CONTACT NAME: John Smith
ADDRESS LINE1: 123 Main Street
ADDRESS LINE2: 300
CITY: Rockville
STATE/PROVINCE/TERRITORY: Maryland
ZIP CODE: 20852
COUNTRY/AREA: UNITED STATES
TELEPHONE NUMBER: 1 301 1212121
EMAIL ADDRESS: [email protected]
The undersigned verifies that the products that are the subject of this application are not adulterated or misbranded and meet
the other requirements of the FD&C Act for marketing in the U.S. or cannot be lawfully marketed in the U.S. but meet the
requirements of section 801(e) of the FD&C Act. Further the requester hereby presents and acknowledges that the company is
aware that in making this request the company is subject to the terms and provisions of Title 18, Section 1001, United States
Code which makes it a criminal offense to falsify, conceal, or cover up a material fact; make any material false, fictitious, or
fraudulent statement or representation; or make or use any false writing or document knowing the same to contain any
materially false, fictitious, or fraudulent statement or entry.
✔
I Agree
Not For Public Disclosure
Your FCE Number is 21920
Please keep the FCE number for your records. The FCE number is required for all
communications with FDA regarding this Registration. Please refer to the help section for more
details.
| File Type | application/pdf |
| File Title | Registration Step 1 |
| File Modified | 2012-01-31 |
| File Created | 2012-01-19 |