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 October 17th, 2024)
F-2 (1149k)
 
F-5 Bulk and Bottled Water Establishment Application
(Updated February 3rd, 2025)
F-5 (1041k)
F-5 Instructions (219k)  
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)
 
F-13 Renewal or Discontinuation Application to Operate a Wholesale Drug or Medical Device Business
(Updated October 17th, 2024)
F-13 (427k)
 
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
(Updated February 28th, 2025)
F-29 (1177k)
 
F-30 Satisfactory Placard
pdf (26k)
doc (246k)
Note  
F-30a Alternative Satisfactory Placard
F-30a (876k)
 
F-31 Unsatisfactory Placard
pdf (26k)
doc (245k)
Note  
F-31a Alternative Unsatisfactory Placard
F-31a (781k)
 
F-32 Conditionally Satisfactory Placard
pdf (26k)
doc (247k)
Note  
F-32a Alternative Conditionally Satisfactory Placard
F-32a (784k)
 
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-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
(Updated May 29th, 2024)
F-48 (796k)
 
F-49 Quarterly Coliform Report Summary
(Posted February 3rd, 2025)
F-49 (801k)
F-49 Instructions (190k)  
F-50 Analysis Report Summary
(Posted February 3rd, 2025)
F-50 (837k)
F-50 Instructions (128k)
 
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)
 
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
(Updated February 28th, 2025)
F-29 (1177k)
 
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 February 3rd, 2025)
F-5 (1041k)
F-5 Instructions (219k)
 
F-42 Renewal Application for Certification to Sell Bottled Water or Bulk Water
(Replaced by revised F-5 form on June 16th, 2022)
 
F-49 Quarterly Coliform Report Summary
(Posted February 3rd, 2025)
F-49 (801k)
F-49 Instructions (190k)
 
F-50 Analysis Report Summary
(Posted February 3rd, 2025)
F-50 (837k)
F-50 Instructions (128k)  
Shellfish Certification
Form # Form Name/Title Linked File Instruction/ Comments
F-48 Application for Certification to Handle Oysters, Clams or Mussels
(Updated May 29th, 2024)
F-48 (796k)
 
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)
 
Go to Food & Drug Safety Program     Additional Health Department Forms