Cornell Dairy Foods Process Review: Client Registration Information Company Name (if chosen) Contact Name Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Telephone Email Co-packer if known/used FDA FSMA Exemption Information (please check) Are you aware of the FSMA Rule/Exemptions? Are you aware of the FSMA Rule/Exemptions? Yes No A little Unsure Do you have a Food Safety Plan? Do you have a Food Safety Plan? Yes No Unsure Do you have a Recall Plan? Do you have a Recall Plan? Yes No Unsure What is the amount of your Annual Gross Sales over the past 3 years? What is the amount of your Annual Gross Sales over the past 3 years? Less than $1 million Less than $500,000 What is your Number of Employees? What is your Number of Employees? Less than 10 Between 10-100 More than 100 Specify criteria that apply to your business Business Type / Intended Place of Manufacture Small Food Entrepreneur Incubator/Commercial Kitchen Co-packer Farm Service Provider Other… Enter other… Product Types Fluid Milk Specialty Milk Cheese Yogurt Greek Yogurt Ice Cream Other Cultured Dairy Powder Other… Enter other… Choose the processing most applicable to the product being reviewed: Hot fill Capable Need Help Fresh: Non-heat Treated Capable Need Help Frozen / IQF Capable Need Help Dehydrating / Drying Capable Need Help Ingredients: Sanitation/Certified Pathogen Free Capable Need Help Preservatives Capable Need Help Vat Pasteurization / HTST Pasteurization Capable Need Help Vacuum Packaging Capable Need Help Product and Processing Notes Describe your finished product: Please provide a process narrative from beginning to end. Include type of ingredients, equipment, and processing steps: (If you have a completed process narrative as a separate document, please upload it or email it directly to rdr10@cornell.edu with the subject: Process Narrative for Scheduled Process) If you have a completed process narrative as a separate document, please upload it here: One file only.10 MB limit.Allowed types: txt, rtf, pdf, doc, docx. Information supplied through this form is proprietary and confidential. No part of this document may be disclosed in any manner to a third party without the prior written consent of the entity specified above. Pricing, Payment and Results In order to receive final documentation, payment ($500) must made first. Payment may be made online, over the phone or by check (options are listed on the invoice with how to make payment) Online: bit.ly/CornellProcessAuthority By Check: Contact Louise Felker at lmf226@cornell.edu to request an invoice.
