To be completed by all food facilities. | TYPE OF ACTIVITY CONDUCTED AT THE FACILITY Optional - Check all types of operations that are performed at this facility regarding the manufacturing/processing, packing or holding of food. |
IF NONE OF THE MANDATORY CATEGORIES BELOW APPLY, SELECT BOX 39. | Warehouse / Holding Facility (e.g., storage facilities, including storage tanks, grain elevators) | Acidified / Low Acid Food Processor | Interstate Conveyance Caterer / Catering Point | Molluscan Shellfish Establishment | Commissary | Contract Sterilizer | Labeler / Relabeler | Manufacturer / Processor | Repacker / Packer | Salvage Operator (Reconditioner) |
| 1. ACIDIFIED FOODS (AF) [21 CFR 114.3(b)] | | | | | | | | | | |
| 2. ALCOHOLIC BEVERAGES [21 CFR 170.3 (n) (2)] | | | | | | | | | | |
| 3. BABY (INFANT AND JUNIOR) FOOD PRODUCTS Including Infant Formula | | | | | | | | | | |
| 4. BAKERY PRODUCTS, DOUGH MIXES, OR ICINGS [21 CFR 170.3 (n) (1), (9)] | | | | | | | | | | |
| 5. BEVERAGE BASES [21 CFR 170.3 (n) (3), (35)] | | | | | | | | | | |
| 6. CANDY WITHOUT CHOCOLATE, CANDY SPECIALTIES AND CHEWING GUM [21 CFR 170.3 (n) (6), (9), (25), (38)] | | | | | | | | | | |
| 7. CEREAL PREPARATIONS, BREAKFAST FOODS, QUICK COOKING / INSTANT CEREALS [21 CFR 170.3 (n) (4)] | | | | | | | | | | |
| 8. CHEESE AND CHEESE PRODUCT CATEGORIES [21 CFR 170.3 (n) (5)] | | | | | | | | | | |
| a. Soft, Ripened Cheese | | | | | | | | | | |
| b. Semi-Soft Cheese | | | | | | | | | | |
| c. Hard Cheese | | | | | | | | | | |
| d. Other Cheeses and Cheese Products | | | | | | | | | | |
| 9. CHOCOLATE AND COCOA PRODUCTS [21 CFR 170.3 (n) (3), (9), (38), (43)] | | | | | | | | | | |
| 10. COFFEE AND TEA [21 CFR 170.3 (n) (3), (7)] | | | | | | | | | | |
| 11. COLOR ADDITIVES FOR FOODS [21 CFR 170.3 (o) (4)] | | | | | | | | | | |
| 12. DIETARY CONVENTIONAL FOODS OR MEAL REPLACEMENTS (Includes Medical Foods) [21 CFR 170.3 (n) (31)] | | | | | | | | | | |
| 13. DIETARY SUPPLEMENT CATEGORIES | | | | | | | | | | |
| a. Proteins, Amino Acids, Fats and Lipid Substances [21 CFR 170.3 (o) (20)] | | | | | | | | | | |
| b. Vitamins and Minerals | | | | | | | | | | |
| c. Animal By-Products and Extracts | | | | | | | | | | |
| d. Herbals and Botanicals | | | | | | | | | | |
| 14. DRESSING AND CONDIMENTS [21 CFR 170.3 (n) (8), (12)] | | | | | | | | | | |
| 15. FISHERY / SEAFOOD PRODUCT CATEGORIES [21 CFR 170.3 (n) (13), (15), (39), (40)] | | | | | | | | | | |
| a. Fin Fish, Whole or Filet | | | | | | | | | | |
| b. Shellfish | | | | | | | | | | |
| c. Ready to Eat (RTE) Fishery Products | | | | | | | | | | |
| d. Processed and Other Fishery Products | | | | | | | | | | |
| 16. FOOD ADDITIVES, GENERALLY RECOGNIZED AS SAFE (GRAS) INGREDIENTS, OR OTHER INGREDIENTS USED FOR PROCESSING [21 CFR 170.3 (n) (42); 21 CFR 170.3 (o) (1), (2), (3), (5), (6), (7), (8), (9), (10), (11), (12), (13), (14), (15), (16), (17), (18), (19), (22), (23), (24), (25), (26), (27), (28), (29), (30), (31), (32)] | | | | | | | | | | |
| 17. FOOD SWEETENERS (NUTRITIVE) [21 CFR 170.3 (n) (9) (41), 21 CFR 170.3 (o) (21)] | | | | | | | | | | |
| 18. FRUIT AND FRUIT PRODUCTS [21 CFR 170.3 (n) (16), (27), (28), (35), (43)] | | | | | | | | | | |
| a. Fresh Cut Produce | | | | | | | | | | |
| b. Raw Agricultural Commodities | | | | | | | | | | |
| c. Other Fruit and Fruit Products | | | | | | | | | | |
| 19. FRUIT OR VEGETABLE JUICE, PULP OR CONCENTRATE PRODUCTS [21 CFR 170.3 (n) (3), (16), (35)] | | | | | | | | | | |
| 20. GELATIN, RENNET, PUDDING MIXES, OR PIE FILLINGS [21 CFR 170.3 (n) (22)] | | | | | | | | | | |
| 21. ICE CREAM AND RELATED PRODUCTS [21 CFR 170.3 (n) (20), (21)] | | | | | | | | | | |
| 22. IMITATION MILK PRODUCTS [21 CFR 170.3 (n) (10)] | | | | | | | | | | |
| 23. LOW ACID CANNED FOOD (LACF) PRODUCTS [21 CFR 113.3(n)] | | | | | | | | | | |
| 24. MACARONI OR NOODLE PRODUCTS [21 CFR 170.3 (n) (23)] | | | | | | | | | | |
| 25. MEAT, MEAT PRODUCTS AND POULTRY (FDA REGULATED) [21 CFR 170.3 (n) (17), (18), (29), (34), (39), (40)] | | | | | | | | | | |
| 26. MILK, BUTTER, OR DRIED MILK PRODUCTS [21 CFR 170.3 (n) (12), (30), (31)] | | | | | | | | | | |
| 27. MULTIPLE FOOD DINNERS, GRAVIES, SAUCES AND SPECIALTIES [21 CFR 170.3 (n) (11) (14), (17), (18), (23), (24), (29), (34), (40)] | | | | | | | | | | |
| 28. NUTS AND EDIBLE SEED PRODUCT CATEGORIES [21 CFR 170.3 (n) (26), (32)] | | | | | | | | | | |
| a. Nut and Nut Products | | | | | | | | | | |
| b. Edible Seed and Edible Seed Products | | | | | | | | | | |
| 29. PREPARED SALAD PRODUCTS [21 CFR 170.3 (n) (11), (17), (18), (22), (29), (34), (35)] | | | | | | | | | | |
| 30. SHELL EGG AND EGG PRODUCT CATEGORIES [21 CFR 170.3 (n) (11), (14)] | | | | | | | | | | |
| a.Chicken Egg and Egg Products | | | | | | | | | | |
| b. Other Eggs and Egg Products | | | | | | | | | | |
| 31. SNACK FOOD ITEMS (FLOUR, MEAL OR VEGETABLE BASE) [21 CFR 170.3 (n) (37)] | | | | | | | | | | |
| 32. SPICES, FLAVORS, AND SALTS [21 CFR 170.3 (n) (26)] | | | | | | | | | | |
| 33. SOUPS [21 CFR 170.3 (n) (39), (40)] | | | | | | | | | | |
| 34. SOFT DRINKS AND WATERS [21 CFR 170.3 (n) (3), (35)] | | | | | | | | | | |
| 35. VEGETABLE AND VEGETABLE PRODUCT CATEGORIES [21 CFR 170.3 (n) (19), (36)] | | | | | | | | | | |
| a. Fresh Cut Products | | | | | | | | | | |
| b. Raw Agricultural Commodities | | | | | | | | | | |
| c. Other Vegetable and Vegetable Products | | | | | | | | | | |
| 36. VEGETABLE OILS (INCLUDES OLIVE OIL) [21 CFR 170.3 (n) (12)] | | | | | | | | | | |
| 37. VEGETABLE PROTEIN PRODUCTS (SIMULATED MEATS) [21 CFR 170.3 (n) (33)] | | | | | | | | | | |
| 38. WHOLE GRAINS, MILLER GRAIN PRODUCTS (FLOURS), OR STARCH [21 CFR 170.3 (n) (1), (23)] | | | | | | | | | | |
| 39. IF NONE OF THE ABOVE FOOD CATEGORIES APPLY, THEN PRINT THE APPLICABLE FOOD CATEGORY OR CATEGORIES (THAT DOES NOT OR DO NOT APPEAR ABOVE). | | | | | | | | | | |
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