Produce Safety Rule Exemption Application

MDAC Produce Safety Division · #submit_id

Contact Information

#section_rows_start(2953)

Contact #section_row_number

#text(#field(17587)) #text(#field(17588))

#text(#field(17589))

#text(#field(17590))

#section_rows_end

Farm Information

Farm Name

#text(#field(17567))

Addresses

Farm (Physical) Address

#text(#field(17572))

#if(#field(17573))

#text(#field(17573))

#endif

#text(#field(17574)), #text(#field(17575)) #text(#field(17576))

#if(#field(17646))

County: #text(#field(17646))

#endif

Mailing Address

#if("#text(#field(17579))" == "Mailing address is the same as the farm (physical) address")

Same as farm (physical) address

#endif#if("#text(#field(17579))" != "Mailing address is the same as the farm (physical) address")

#text(#field(17580))

#if(#field(17581))

#text(#field(17581))

#endif

#text(#field(17582)), #text(#field(17583)) #text(#field(17584))

#endif

Other Information

Farmers Market

#text(#field(17570))

Farm Size (avg food sales)

#text(#field(17595))

Protected Well

#text(#field(17597))

Surface Water

#text(#field(17598))

City or Rural Water

#text(#field(17599))

Other Water

#text(#field(17600))

Soil Amendments of Animal Origin

#text(#field(17602))

Plant Date

#text(#field(17603))

Harvest End Date

#text(#field(17604))

Acreage Farmed

#text(#field(17605))

Farm Operations

#checkbox_label(17606, ", ")

Crop Selection

Covered Produce

#checkbox_label(17612, ", ")

#if(#field(17613))

Other: #text(#field(17613))

#endif

Non-Covered Produce

#checkbox_label(17614, ", ")

Training & Review

PSA grower training taken

#text(#field(17619))

Date PSA training taken

#if("#text(#field(17619))" == "Yes")#text(#field(17620))#endif#if("#text(#field(17619))" != "Yes")N/A#endif

On-Farm Readiness Review desired

#text(#field(17621))

Submission

Submission ID

#submit_id