ࡱ> k `bjbj:: /XГ\XГ\?11>>>>>d>>>?d I >Z Sb>brr<N$ t>">>rf *222>r>222~Q8rq$'*X <Z 2z>52Z 1> Z=: Instructions: This Organic System Plan application is designed to describe how your operation complies or plans to comply with the requirements of the Canada Organic Regime and equivalent organic standard(s). Complete all sections truthfully and accurately. Submit the completed application along with the Fee Payment Form and applicable fees to QCS by e-mail to  HYPERLINK "mailto:apply@qcsinfo.org" apply@qcsinfo.org or by mail to the address listed above. Maintain a copy of the completed application for your own records to ensure that the submitted plan is consistent with practices on your operation. All changes that may affect compliance must be notified to QCS and approved prior to implementation, including use of new lands, inputs, or facilities. Facilities and products must be approved by QCS and listed on the Organic Certificate Addendum (Product Verification Form) before they are represented as organic or are used to produce products represented as organic. OHP 1:Application Safe Food for Canadians Regulations, Part 13, Div. 4, Subdiv A, Application (paras 344-348) and CAN/CGSB-32.310, clause 4A. CONTACT INFORMATIONLegal name of Entity:  FORMTEXT      Operation Name:  FORMTEXT      QCS No.  FORMTEXT      Date  FORMTEXT      Mailing Address:  FORMTEXT       FORMTEXT       Physical Address:  FORMCHECKBOX  Same as mailing address City:  FORMTEXT      State:  FORMTEXT      Zip Code:  FORMTEXT      City:  FORMTEXT      State:  FORMTEXT      Zip Code:  FORMTEXT      Country:  FORMTEXT      Country:  FORMTEXT      Phone:  FORMTEXT      Fax:  FORMTEXT      Phone:  FORMTEXT      Fax:  FORMTEXT      CERTIFICATION CONTACTS (Authorized Representative) Persons listed below are authorized to communicate with QCS on behalf of this operation.NameRole in Operation (Owner, Manager, Billing, etc.) PhoneE-mail FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      ADDITIONAL COPIES OF ORGANIC CERTIFICATE  FORMCHECKBOX  None Provide the name(s) and contact information for any additional person(s) that should receive a copy of your organic certificate:CONSULTANTS  FORMCHECKBOX  Not Applicable (not using a consultant) (Please note that it is your responsibility to update QCS of any modifications to the consultant information).Name:  FORMTEXT      Phone:  FORMTEXT      E-mail:  FORMTEXT      How would you like QCS to communicate with the consultant?  FORMTEXT       FORMCHECKBOX  No direct communication with the consultant FORMCHECKBOX  Copy the consultant on all communication FORMCHECKBOX  Send copies of all documents (certificates, applications, etc.) to the consultant  FORMCHECKBOX  Other (specify)  FORMTEXT      DRIVING DIRECTIONS Please provide directions to the main operation for the inspector:  FORMCHECKBOX  Attachment  FORMTEXT       B. OPERATION S LEGAL DESCRIPTION  FORMCHECKBOX  Attachment Please check the legal description that best fits your operation. Attach applicable documents showing legal description (e.g. incorporation, partnership agreement, registration, fictitious name filing) FORMCHECKBOX  A Sole Proprietorship operating under an individual name or a fictitious name (dba)  FORMCHECKBOX  A Corporation (For Profit, Not for Profit, or LLC)  FORMCHECKBOX  A Partnership  FORMCHECKBOX  Other unincorporated Association C. PROCESSING/HANDLING AND STORAGE FACILITIES (TO BE) USED FOR ORGANIC PRODUCTION, INCLUDING OFF-SITE STORAGE Please note, off-site storage (owned or rented/contractors) may require attestation of complianceFacility NamePhysical AddressFunction (e.g. ingredient storage, processing, etc.)Production Status (Check One)Organic onlySplit (organic & conventional) FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX D. GENERAL DESCRIPTION Please indicate the categories that you are applying for under COR: Organic Product Certificate  Yes  FORMCHECKBOX  No  FORMCHECKBOX Check yes if you are processing or manufacturing a product containing one or more organic ingredients for sale as organic. Describe all products requesting certification in this category in OHP 2 and OHP 3. For all processed agricultural product containing more than one agricultural ingredient and provide a statement setting out the percentage by weight of each of those products and the percentage by weight of each of them that are organic in OHP 3. What activities does this operation perform on organic products? (check all that apply)  FORMCHECKBOX  Cooking  FORMCHECKBOX  Baking  FORMCHECKBOX  Curing  FORMCHECKBOX  Heating  FORMCHECKBOX  Drying  FORMCHECKBOX  Mixing  FORMCHECKBOX  Grinding  FORMCHECKBOX  Churning  FORMCHECKBOX  Separating  FORMCHECKBOX  Distilling  FORMCHECKBOX  Extracting  FORMCHECKBOX  Slaughtering  FORMCHECKBOX  Cutting  FORMCHECKBOX  Fermenting  FORMCHECKBOX  Preserving  FORMCHECKBOX  Dehydrating  FORMCHECKBOX  Freezing  FORMCHECKBOX  Chilling  FORMCHECKBOX  Cleaning  FORMCHECKBOX  Milling  FORMCHECKBOX  Wine Production  FORMCHECKBOX  Canning/Jarring  FORMCHECKBOX  Other, please explain:  FORMTEXT       Certificate of Packaging & Labeling ActivitiesYes  FORMCHECKBOX  No  FORMCHECKBOX Check  yes if you are providing packaging and/or labeling activities for organic products that were processed or manufactured at a different operation. List all products requesting certification in this category and the certified organic supplier in OHP 3. What activities does this operation perform on organic products? (check all that apply)  FORMCHECKBOX  Packaging  FORMCHECKBOX  Labeling  FORMCHECKBOX  Other, please explain:  FORMTEXT       Attestation of ComplianceYes  FORMCHECKBOX  No  FORMCHECKBOX Check  yes if you are handling organic products that you do not process, manufacture, package or label. What activities does this operation perform on organic products? (check all that apply)  FORMCHECKBOX  Storage of packaged organic products  FORMCHECKBOX  Transportation of bulk organic products  FORMCHECKBOX  Seed cleaning  FORMCHECKBOX  Other, please explain:  FORMTEXT        1. What percentage of processing/handling performed at this operation is organic (versus conventional)?  FORMTEXT       % E. Certification Status Have you ever applied for organic certification in the past?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please specify the year(s) of application and the name of the certifier(s) applied to:  FORMTEXT       Complete the remaining questions in this section only if the operation has previously applied for certification Is this operation currently certified?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If certified by an accredited certification agency other than QCS, please attach a copy of your current organic certificate. Note that COR does not permit certification by multiple certifiers.  FORMCHECKBOX  Attachment  FORMTEXT       If currently certified by another certifier, were you issued noncompliance(s) in the previous review?  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A If yes, have you received written confirmation that your noncompliance(s) have been corrected?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Have you ever applied for and been denied organic certification?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, attach a copy of the denial from the certifier.  FORMCHECKBOX  Attachment  FORMTEXT       Has the operation s certificate ever been suspended or cancelled?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, attach a copy of the suspension or cancellation from the previous certifier.  FORMCHECKBOX  Attachment  FORMTEXT       F. Export 1. Please indicate which countries you are seeking certification or compliance verification.  FORMCHECKBOX  European Union Equivalency (complete OHP 9)  FORMCHECKBOX  US-Canada Equivalency (complete OHP 10)  FORMCHECKBOX  Other (please specify)  FORMTEXT        OHP 2: Products Requested for Certification List all products requested for certification in the table below. Complete OHP and fill out the Organic Product Profile for each item separately. Make additional pages as necessary. Product NameBrand Name(s) or other ID Mark (unit size, net wt.)Type of Certification RequestedPackaging and Label(s) (Check all that apply)Organic Product Certificate (Complete OHP 3)Certificate of Packaging and Labeling Activities List supplier and attach organic certificateRetail Non-retail/ wholesaleNone (product not sold) FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT        FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Attach all unique retail labels in use or intended for use for each product requested for certification.  FORMCHECKBOX  Attachment All labels used on retail packaging must be reviewed and approved by QCS prior to printing on packaging, stickers, etc.COR LABELING REQUIREMENTSRetail labels % of organic ingredients: Retail labels may display the percentage of organic ingredients. The size of the words organic ingredients must be displayed in characters of the same height and prominence as the words, numbers, signs or symbols that indicate the percentage of organic ingredients. Percentage of organic ingredients must be displayed as a whole number, rounded down from the percentage calculation of the product formulation as show on OHP 3: Organic Product Profile Ingredient statement: Organic ingredients may be identified in the ingredient statement with the word organic or with an asterisk or other reference mark below the ingredient statement to indicate the ingredient is organically produced. Water and salt may not be identified as organic. Certifier identification: Retail labels must display the name of the certification body that certified the food commodity as organic. Retail labels may display the seal, logo, or other identifying mark of the organic certifying agent. If the certifier seal or logo is used it must be displayed less prominently than the Canada Organic Logo, if also used. Canada Organic Logo may only be displayed only on labels of products in the organic labeling category. If used, the logo must replicate the exact form and design provided in the Canada Organic Regulation and be printed legibly and conspicuously.Non-retail (wholesale) Labels used to transport or store raw or processed productsLot numbers: non-retail containers used for transport or storage of organic product must display the production lot number of the product. Certifier identification: Retail labels must display the name of the certification body that certified the food commodity as organic. Retail labels may display the seal, logo, or other identifying mark of the organic certifying agent. Canada Organic Logo may only be displayed only on labels of products in the organic labeling category. Export. Non-retail containers intended for export must be labelled in accordance with the requirements of the destination country. Containers or accompanying documents must be marked For Export Only. CALCULATING THE PERCENTAGE OF ORGANIC INGREDIENTS IN MULTI-INGREDIENT PROCESSED PRODUCTSSolid Products (except livestock feed): Divide the net mass, excluding water and salt, of all organic ingredients in the formulation or finished product, whichever is more relevant, by the net mass, excluding water and salt, of all ingredients. Liquid Products: If the product and its ingredients are liquid, divide the fluid volume of all organic ingredients, excluding water and salt, by the fluid volume of all ingredients, excluding water and salt. If the principal display panel, specification sheet or certificate of analysis uses phrases like reconstituted from concentrates to describe the final product, single-strength concentrations of the ingredients or the finished product shall be used to calculate organic percentages. Any user of an ingredient, to which water or salt has been added by a prior processor, and is declared as water or salt on the ingredient declaration of the finished product is required to exclude this added water or salt when calculating organic percentages. Solid Products and Liquid Products: Divide the combined net mass of solid organic ingredients and the net mass of liquid organic ingredients, excluding water and salt, by the total mass, excluding water and salt, of all ingredients in the finished product. Any user of an ingredient, to which water or salt has been added by a prior processor, and is declared as water or salt on the ingredient declaration of the finished product is required to exclude this added water or salt when calculating organic percentages. Livestock feed shall contain 100% organic agricultural ingredients and necessary feed additives or supplements listed in Table 5.2 of CAN/CGSB -32.311 divide the total net mass, excluding water, salt and calcium compounds, of combined organic ingredients in the formulation or the finished product, whichever is more relevant, by the total mass, excluding water, and salt and calcium compounds, of all ingredients. The percentage of all organic ingredients in an organic product shall be rounded down to the nearest whole number. OHP 3: Organic Product Profile (OPP)CAN/CGSB-32.310, Section 9Please complete an organic product profile for each product requested for certification. Organic Product Profiles must be kept current throughout the year and any changes must be submitted to QCS for review and approval. If certification is requested for packaged finished products, please complete the organic product profile for each product. Name of the Product Requested for Certification:  FORMTEXT      List ID Marks/Brands, unit size, and/or net wt. of products using this OPP:  FORMTEXT      Labeling Category:  FORMCHECKBOX  Organic (> 95% organic content)  FORMCHECKBOX  70-95% content Percentage organic ingredients* (See guidance on previous page):  FORMTEXT      Is a contract service (i.e. packaging, labeling, storage, transportation) used for this product?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, Describe contract service(s)?  FORMTEXT       Name of contract service provider(s):  FORMTEXT        FORMCHECKBOX  Attach Organic Certificate or Attestation of Compliance for each contract service provider. Section A: Mark one of the following:  FORMCHECKBOX  Product Processed and Handled  FORMCHECKBOX  List of Only Packaged Finished Products List below all ingredients and/or processing aids (including water and salt) used in processing this product, check the applicable boxes and supply the requested information. Add more rows if necessary. Attach the current organic certificate for each organic ingredient or processing aid listed in Section A above.  FORMCHECKBOX  Attachment If any of your suppliers are not directly certified to COR and instead to the terms of an Equivalency Arrangement that Canada has with the suppliers home country, please ensure that all relevant equivalency compliance documentation is supplied. Complete Section B: Nonorganic Ingredients & Processing Aids for each nonorganic ingredient and processing aid and attach C. Nonorganic Ingredient Disclosure completed by each supplier.  FORMCHECKBOX  Attachment IngredientsIngredientStatus% OrganicName of Supplier(s) List more than one if applicableCertifying Agent of Supplier(s)% of Finished Product FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Processing AidsProduct NameStatusSupplier/ ManufacturerCertifying Agent of Supplier(s) (if applicable)Function FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  Organic  Complete Section B  FORMCHECKBOX  Non organic  Complete Section C FORMTEXT       FORMTEXT       FORMTEXT      SECTION B: NONORGANIC INGREDIENTS & PROCESSING AIDS For a current list of CAN/CGSB 32.311-2020 Permitted Substances List, go to:  HYPERLINK "http://www.publications.gc.ca/site/eng/9.894398/publication.html" http://www.publications.gc.ca/site/eng/9.894398/publication.html Nonorganic nonagricultural substances used as ingredients or processing aids are allowed only when produced in accordance with the restrictions specified in CAN/CGSB-32.310, Section 9.2 and per the Permitted Substances list. For each nonagricultural ingredient/processing aid listed in Section A of the Organic Product Profile(s), attach written verification from each supplier, including signature and date, attesting that the ingredient or processing aid was produced or handled 1) without any products of and materials from genetic engineering (GE), as defined in CAN/CGSB-32.310, and as specified in 4.1.3, 5.1.2 and 6.2.1 of CAN/CGSB-32.311; 2) without any products, materials or processes intentionally using nanotechnology, as defined in CAN/CGSB-32.310, with the following exceptions: naturally occurring nano-sized particles or those produced incidentally through processes such as grinding flour; contact surfaces, such as equipment, work surfaces, or packaging, where transference of nano-sized particles to organic crops, livestock or products is unintended and unlikely to occur; 3) without irradiation, as defined in CAN/CGSB 32.310 for the treatment of organic products and inputs used in the production of organic products, except as specified in CAN/CGSB-32.311; 4) without cloned livestock and its descendants; 5) without equipment, harvest and storage containers, storage facilities and packaging materials treated with fungicides, preservatives, fumigants and pesticides not listed in CAN/CGSB-32.311, except as permitted in 8.2.3 and 8.3.3 of CAN/CGSB-32.310; 6) without sewage sludge; 7) without non-organic ingredients, food additives and processing aids, including sulphates, sulphites, nitrates and nitrites, except as permitted by this standard or specified in CAN/CGSB-32.311; 6); and 7) without substances that are not listed in CAN/CGSB-32.311, except as permitted in this standard. Section D, QCS Ingredient and Excluded Methods Disclosure may be completed by the supplier as the written verification described above, and submitted with your application for compliance review by QCS.  FORMCHECKBOX  N/A  FORMCHECKBOX  Attachment Nonorganic agricultural substances used as ingredients or processing aids are allowed only when an organic form is not commercially available and require documentation confirming compliance with CAN/CGSB-32.310, clause 1.4 (a), 1.4 (c) and 1.4 (d) (regarding genetic engineering, irradiation and cloned livestock respectively). Please contact the QCS office for description of determination of commercial availability if needed. For each nonorganic agricultural ingredient/processing aid listed in Section A of the Organic Product Profile(s), supply written verification that the product was not commercially available organically.  FORMCHECKBOX  N/A  FORMCHECKBOX  Attachment  SECTION C: NON-ORGANIC INGREDIENT DISCLOSURE This Non-organic Ingredient Disclosure must be completed by the manufacturer/supplier of each non-organic ingredient and processing aid. Equivalent documentation may be copied and sent. Once completed and returned to you by the manufacturer/supplier, submit this disclosure to QCS for review and consideration. Copy and paste to company letterhead for optimal usage of the form.Dear Vendor:  FORMTEXT       In order to maintain our organic certification and to market our finished product as  organic or containing  XX% organic ingredients , we are required to obtain information for nonorganic ingredients and processing aids to ensure the substance we purchased is allowed for use according to the description and annotations as defined under the Canada Organic Regime. Please supply responses to the questions listed below. Company Name:  FORMTEXT       Name of Ingredient/Vendor product no:  FORMTEXT       Ingredient Disclosure Attach Product Specification Sheet and, if not listed on the specification sheet, a list of all ingredients including but not limited to carriers and preservatives.  FORMCHECKBOX  Attachment Does the product meet the restrictions specified in the Permitted Substances List?  FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A Is this product a flavour, or does it contain flavours? If yes, complete section C. Flavours  FORMCHECKBOX  Yes  FORMCHECKBOX  No Is this product produced using synthetic solvents (hydrocarbons, chlorinated, halogenated)? If yes, please specify:  FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No Has this product (including its constituents) been exposed to Irradiation (as defined in CAN/CGSB-32.310, Section 1.4.1.c)? If yes, please specify:  FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No Have the agricultural components of this product been grown on land fertilized with sewage sludge? Sewage Sludge is defined as solid, liquid or semisolid residues generated by municipal or industrial sewage treatment facilities, including but is not limited to: domestic septage; scum or solids removed in primary, secondary or advanced wastewater treatment processes; or material derived from sewage sludge. If yes, please specify:  FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No Has the product been produced using nanotechnology as defined in CAN/CGSB-32.310 clause 3.45 and does the product contain any nanomaterials that are intentionally added? If yes, please specify:  FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No Has the product had any direct contact with any equipment, harvest and storage containers, storage facilities and packaging materials treated with fungicides, preservatives, fumigants and pesticides or that were produced with nanotechnology intended to transfer to the product? If yes, please specify:  FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No For Salt only: Does the salt contain any free flowing and anticaking agents? If yes, please specify?  FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No Genetic Engineering Genetic engineering is prohibited in the Canada Organic Regime in CAN/CGSB-32.310 clause 1.4 a) and as specified in 4.1.3, 5.1.2 and 6.2.1 of CAN/CGSB-32.311. Genetic engineering is defined in CAN/CGSB-32.310 clause 3.31 and generally refers to artificial manipulation of living cells for the purpose of altering its genome constitutes genetic engineering and refers to a set of techniques from modern biotechnology by which the genetic material of an organism is changed in a way that does not occur other than through traditional breeding by multiplication or natural recombination. The genome is considered an indivisible entity; artificial technical/physical insertions, deletions, or rearrangements of elements of the genome constitute genetic engineering. Does this product contain ingredients, incidental ingredients, or processing aids that were produced and handled with products of and/or materials from genetic engineering (as defined in CAN/CGSB-32.310, clause 3.31)?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please choose one of the following:  FORMCHECKBOX  The product (including incidental ingredients and processing aids) contains genetically modified DNA and/or proteins derived from genetically modified DNA. Please describe below the source of the genetically modified DNA and/or proteins.  FORMTEXT        FORMCHECKBOX  The product (including incidental ingredients and processing aids) was derived from a genetically modified source material but should not contain genetically modified DNA and/or the proteins derived from genetically modified DNA due to processing which removed them. Please identify the source and describe below the testing method used to verify the absence of GMOs.  FORMTEXT       Was the product produced on substrate or growth media (for example, microorganisms and lactic acid)?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, does the product include the substrate or growth media?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, what is the substrate or growth media?  FORMTEXT       (The substrate or growth media must be listed on Table 6.3, 6.4 or 6.5) If NO, please provide commercial availability documentation to confirm that the substrate or growth media were not available in non-genetically engineered form.  FORMCHECKBOX  Attachment FLAVOURS  FORMCHECKBOX  N/A Substance is not a flavour The use of this questionnaire is to determine compliance of a non-organic flavour under the terms of the Canada Organic Regime. QCS may request additional information as needed. The Canada Organic Regime allows the use of flavours providing they are derived from biological sources (such as plants, meat, seafood, micro-organisms, etc.) using approved methods (see clause11 ofCAN/CGSB-32.310), and permitted carriers and extraction solvents and precipitation aids that are listed in CAN/CGSB.32.311 Table 6.3. Type of flavour (Check all that apply):  FORMCHECKBOX  Compounded flavour  FORMCHECKBOX  Extracts  FORMCHECKBOX  Isolate  FORMCHECKBOX  Compounded WONF  FORMCHECKBOX  Essential oil  FORMCHECKBOX  Oleoresin  FORMCHECKBOX  Distillate  FORMCHECKBOX  Essential oil Isolate  FORMCHECKBOX  Other (specify):  FORMTEXT       Please list all carriers, extraction solvents and precipitation aids used in this flavour ingredient:  FORMCHECKBOX  None  FORMTEXT       Are all flavour constituent(s) made using Canada Organic Regime-suitable extraction solvents*?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If the solvent used to extract the natural flavors is not listed as an example of one of the Canadian Organic -suitable extraction solvents please disclose:  FORMCHECKBOX  N/A  FORMTEXT       This questionnaire is only to be signed by a qualified technical person1 Pursuant to the restrictions as defined in CAN/CGSB-32.310 clauses 1.4 and 1.5 and CAN/CGSB-32.311 (the Permitted Substances Lists), on behalf of the supplier, I hereby attest that the information provided in this form is accurate and truthful to the best of my knowledge. To the best of my knowledge, the above information is true and complete, and the ingredient meets the criteria of the Canada Organic Regime.  FORMTEXT       Date /Signature / Title  OHP 4: Product Process CAN/CGSB-32.310, Clauses 4 and 8A. PRODUCT FLOW Provide a complete written description or schematic product flow chart which describes the movement of all organic products, from incoming/receiving, through production and to outgoing/shipping. Indicate where ingredients are added and/or processing aids are used. Identify equipment and storage areas.  FORMCHECKBOX  Attachment  FORMTEXT      B. BY PRODUCTS  FORMCHECKBOX  Not applicable Will any by-products from the production process be sold as certified organic?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, list all organic by-products and provide Organic Product Profile for each by-product.  FORMCHECKBOX  Attachment  FORMTEXT       C. WATER  FORMCHECKBOX  Not applicable Check ways water is used in organic processing:  FORMCHECKBOX  None used  FORMCHECKBOX  ingredient  FORMCHECKBOX  processing aid  FORMCHECKBOX  cooking  FORMCHECKBOX  cooling  FORMCHECKBOX  product transport  FORMCHECKBOX  cleaning organic products  FORMCHECKBOX  cleaning equipment  FORMCHECKBOX  other (specify)  FORMTEXT       Water source:  FORMCHECKBOX  municipal  FORMCHECKBOX  on-site well  FORMCHECKBOX  other, specify  FORMTEXT       How do you ensure that water used meets or exceeds local safe drinking water standards?  FORMTEXT       What on-site water treatment processes are used?  FORMCHECKBOX  None  FORMTEXT       Are any Incidental Additives used in the process?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, check all that apply:  FORMCHECKBOX  Hand sanitizer substances, if used in direct contact with organic products, shall be listed in Table 7.3 of CAN/CGSB-32.311.  FORMCHECKBOX  Culinary steam, that is, steam used in direct contact with organic products or packaging  FORMCHECKBOX  Food-contact lubricants shall be listed in Tables 6.3-6.5 of CAN/CGSB-32.311  FORMCHECKBOX  Use of cleaners, disinfectants and sanitizers shall comply with the requirements in 8.2 of this standard. How do you ensure the use of incidental additives does not compromise the organic integrity of the ingredient/product?  FORMTEXT       Is a boiler used to create steam used in the processing or packaging of organic products?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, describe how steam is used.  FORMTEXT       If steam has direct contact with organic products, do you use:  FORMCHECKBOX  No direct contact  FORMCHECKBOX  steam filters  FORMCHECKBOX  condensate traps  FORMCHECKBOX  testing of condensate  FORMCHECKBOX  testing of finished products  FORMCHECKBOX  other (specify)  FORMTEXT       If steam has direct contact with organic products or packaging, are boiler additives used?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, attach the MSDS and/or label information to determine whether or not they are volatile and what substances they contain.  FORMCHECKBOX  Attachment OHP 5: Pest Management CAN/CGSB-32.310, Section 8.3A. FACILITY MAP Attach a facility map showing the location of interior and exterior traps and monitors.  FORMCHECKBOX  Attachment B. PEST MANAGEMENT PLAN Do you have a facility pest management plan in place to address the Canada Organic Regime requirements on facility pest management (CAN/CGSB-32.310, Clause 8.3) ? ?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please attach a copy.  FORMCHECKBOX  Attachment Do you work with a pest control company?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, give name and contact information. FORMTEXT       What area of the plant does the pest control company cover?  FORMCHECKBOX  Exterior  FORMCHECKBOX  Interior  FORMCHECKBOX  Both Have you notified the pest control company of the Canada Organic Regime requirements on facility pest management (CAN/CGSB-32.310, clause 8.3) ?  FORMCHECKBOX  Yes  FORMCHECKBOX  No What are your problem pests?  FORMCHECKBOX  No pest problems  FORMCHECKBOX  flying insects  FORMCHECKBOX  crawling insects  FORMCHECKBOX  rodents  FORMCHECKBOX  gophers  FORMCHECKBOX  rats  FORMCHECKBOX  mice  FORMCHECKBOX  spiders  FORMCHECKBOX  birds  FORMCHECKBOX  other pests (specify)  FORMTEXT       Check all pest management measures used at your facility to prevent pests: Stage One  FORMCHECKBOX  good sanitation  FORMCHECKBOX  removal of exterior habitat/food sources  FORMCHECKBOX  removal of breeding areas  FORMCHECKBOX  clean up spilled product  FORMCHECKBOX  exclusion  FORMCHECKBOX  maintaining inhabitable temperatures  FORMCHECKBOX  sealed doors and/or windows  FORMCHECKBOX  repair of holes, cracks, etc.  FORMCHECKBOX  Screened windows, vents, etc.  FORMCHECKBOX  physical barriers  FORMCHECKBOX  sheet metal on sides of building exterior  FORMCHECKBOX  mowing  FORMCHECKBOX  air curtains  FORMCHECKBOX  air showers  FORMCHECKBOX  positive air pressure in facility  FORMCHECKBOX  monitoring  FORMCHECKBOX  incoming ingredient inspection for pests  FORMCHECKBOX  inspection zones around interior perimeter  FORMCHECKBOX  ultrasound/light devices  FORMCHECKBOX  sticky traps  FORMCHECKBOX  electrocutors  FORMCHECKBOX  mechanical traps  FORMCHECKBOX  scare eye balloons  FORMCHECKBOX  freezing treatments  FORMCHECKBOX  heat treatments  FORMCHECKBOX  vacuum treatments  FORMCHECKBOX  carbon dioxide  FORMCHECKBOX  nitrogen  FORMCHECKBOX  material recycling  FORMCHECKBOX  on-site dumpster  FORMCHECKBOX  daily pick-up of waste  FORMCHECKBOX  composting  FORMCHECKBOX  other (specify)  FORMTEXT       Stage Two  FORMCHECKBOX  release of beneficials  FORMCHECKBOX  pheromone traps  FORMCHECKBOX  vitamin baits  FORMCHECKBOX  boric acid  FORMCHECKBOX  diatomaceous earth  FORMCHECKBOX  precipitated silica  FORMCHECKBOX  pyrethrum  FORMCHECKBOX  ryania  FORMCHECKBOX  rotenone  FORMCHECKBOX  disodium octal tetrahydrate  FORMCHECKBOX  other (specify)  FORMTEXT       Stage Three  FORMCHECKBOX  fumigation  FORMCHECKBOX  fogging  FORMCHECKBOX  crack and crevice spray  FORMCHECKBOX  other (specify)  FORMTEXT       C. STAGE ONE: PEST PREVENTION PRACTICES Pest prevention practices must be the first and primary line of defense against pest infestation. Only upon documented use and failure of such measures to control pests may a substance consistent with the Permitted Substances List may be applied, i.e., Stage Two measures. 1. Do you maintain records or supporting documentation demonstrating use of Stage One measures?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoSTAGE TWO: SUBSTANCES LISTED ON THE PERMITTED SUBSTANCES LIST  FORMCHECKBOX  Not Applicable Only when Stage One measures are ineffective, the operator may use pest control substances listed in Tables 8.2 and 8.3 of CAN/CGSB-32.311. Are Stage Two inputs used only when Stage One measures have been proven insufficient?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Which Stage One Preventative Measure(s) proved ineffective?  FORMTEXT       Do you maintain records demonstrating the ineffectiveness of Stage One measures?  FORMCHECKBOX  Yes  FORMCHECKBOX  No List the STAGE TWO Substances used or planned for use and attach and SDS for each substance listed  FORMCHECKBOX  Attachment Substance Target pest Location where used Method of Application Date of last application Status: approved(A) Restricted (R) Prohibited (P)  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       List all measures taken to prevent contact of organically produced products, ingredients, packaging materials, storage containers, etc. with the substances used.  FORMTEXT       Are these measures documented?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoSTAGE THREE: USE OF PEST CONTROL SUBSTANCES NOT LISTED ON THE PERMITTED SUBSTANCES LISTS  FORMCHECKBOX  Not Applicable Only when Stage One and Two measures have failed to control the pest problem, substances not listed in Table 8.2 of CAN/CGSB-32.311 may be used whenever organic product preparation takes place, including off-site storage facilities, provided that there is no risk to organic product status or integrity. Operators shall ensure that organic products and/or the packaging materials are not present when these substances are used indoors. Are Stage Three inputs used only when Stage Two inputs have been proven insufficient?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Which Stage Two measure(s) proved ineffective?  FORMTEXT       Do you maintain records demonstrating the ineffectiveness of Stage Tne measures?  FORMCHECKBOX  Yes  FORMCHECKBOX  No List the STAGE Three Substances used or planned for use and attach and SDS for each substance listed  FORMCHECKBOX  Attachment Substance Target pest Location where used Method of Application Date of last application Status: Approved(A) Restricted (R) Prohibited (P)  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       List all measures taken to prevent contact of organically produced products, ingredients, packaging materials, storage containers, etc. with the substances used.  FORMTEXT       Are these measures documented?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If prohibited pest control products were used, what measures are you taking or planning to take to prevent their use in the future? Are you required by local, provincial or Federal Law and regulation to use a prohibited substance?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, list substance(s) and attach documentation of requirement for use.  FORMCHECKBOX  Attachment  FORMTEXT        OHP 6: Maintaining Organic Integrity CAN/CGSB-32.310, Section 8 (all)Canada Organic Regime requires that handling practices and procedures present no contamination risk to organic products from commingling with non-organic products or contact with prohibited substances. Packaging materials, bins, and storage containers must not have contained fungicides, preservatives, or fumigants. Reusable bags or containers must be clean and pose no risk to the integrity of organic products. Procedures used to maintain organic integrity must be documented.A. PROCESS MONITORING PROGRAMS Briefly describe (or attach) your organic integrity program the procedures in place to prevent commingling with non-organic ingredients/products and contamination from prohibited substances.  FORMCHECKBOX  Attachment  FORMTEXT       What Quality Assurance programs are in place?  FORMCHECKBOX  None  FORMCHECKBOX  ISO  FORMCHECKBOX  HACCP  FORMCHECKBOX  TQM  FORMCHECKBOX  other (specify)  FORMTEXT       Are any outside quality assessment services used (e.g. AIB)?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, name of company:  FORMTEXT       Do you have a product recall system in place?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Do you have a written fraud prevention plan?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please attach.  FORMCHECKBOX  Attachment B. EQUIPMENT List all equipment used in production, including containers used to move ingredients in-process. Equipment NameDedicated organic?Purged/cleaned prior to organic production? Describe cleaning/purging procedures  FORMTEXT       FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMTEXT       FORMTEXT       FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMTEXT       FORMTEXT       FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMTEXT       FORMTEXT       FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMTEXT       FORMTEXT       FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMTEXT      C. SANITATION Food-grade cleaners, disinfectants and/or sanitizers listed in Table 7.3 of CAN/CGSB-32.311 may be on organic product contact surfaces, which include equipment, storage and transport units; and/or in direct contact with organic products. If substances in Table 7.3 are ineffective, cleaners, disinfectants and/or sanitizers listed in Table 7.4 of CAN/CGSB-32.311 may be used on organic product contact surfaces, provided that documentation demonstrates they are used as annotated; and removal event(s) have eliminated the substance(s) from organic product contact surfaces prior to organic production. If substances in Table 7.4 are ineffective, other cleaners, disinfectants and/or sanitizers may be used on organic product contact surfaces, provided that documentation demonstrates: the efficacy of the alternative substance(s); and removal event(s) have eliminated the alternative substance(s) from organic product contact surfaces prior to organic production; and that effluent discharge was neutralized to minimize negative impact on the environment. Check all methods used for facility sanitation below:  FORMCHECKBOX  sweeping  FORMCHECKBOX  scraping  FORMCHECKBOX  vacuuming  FORMCHECKBOX  compressed air  FORMCHECKBOX  manual washing  FORMCHECKBOX  clean in place (CIP)  FORMCHECKBOX  steam cleaning  FORMCHECKBOX  sanitizing  FORMCHECKBOX  other (specify)  FORMTEXT       Describe use of cleaners, sanitizers and defoamers in the table below and attach the Safety Data Sheet (SDS) and label for each product.  FORMCHECKBOX  Attachment Name of Cleaner/Sanitizer/ Defoamer Function Location(s) of Use Status: (7.3) Table 7.3 (7.4) Table 7.4 (NL) Not listed Is there direct contact with organic ingredients/product (e.g. in wash water)? Is there an intervening event after use (e.g. rinse, purge)?  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No Do you test food contact surfaces to ensure that the intervening event was sufficient to remove cleanser and sanitizer residues?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, are the test results documented?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please explain process.  FORMTEXT       For each equipment cleaner and sanitizer not listed at Table 7.3 or Table 7.4: Describe how you determined that substances listed on Table 7.4 are not effective:  FORMTEXT       Attach documentation demonstrating the substance s efficacy:  FORMCHECKBOX  Attachment Describe how effluent discharge was neutralized to minimize negative impact on the environment:  FORMTEXT       Where are cleaning/sanitizing materials stored?  FORMTEXT       D. STORAGE CONTAINERS & PACKAGING Check types of storage containers and packaging material used:  FORMCHECKBOX  paper  FORMCHECKBOX  cardboard  FORMCHECKBOX  wood  FORMCHECKBOX  glass  FORMCHECKBOX  metal  FORMCHECKBOX  foil  FORMCHECKBOX  plastic  FORMCHECKBOX  waxed paper  FORMCHECKBOX  aseptic  FORMCHECKBOX  natural fiber  FORMCHECKBOX  synthetic fiber  FORMCHECKBOX  other (specify)  FORMTEXT       Are packaging materials and/or storage containers exposed to prohibited pesticides, fungicides or preservatives, including fumigants?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, describe exposure, including name of products used, and measures taken to ensure that a prohibited substance does not come into contact with packaging materials.  FORMTEXT       Do you maintain documentation from the supplier of your packaging materials to confirm that they are compliant with CAN/CGSB-32.310, clause 8.1.6 c) ?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Are storage containers and/or packaging materials reused?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, describe how they are cleaned prior to use.  FORMTEXT       Are any packaging materials dedicated organic?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoE. STORAGE 1. 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jhECJUaJjqhECJUaJjhECJUaJ%jhECJUaJmH sH hECJaJhg3;h5:6\aJ%jhECJUaJmH sH hECJaJmH sH jhECJUaJmH sH hEhE5\^JaJ#HHHHTI|I@3333 f!$Ifgd5:kd$$Ifl\l) "  t0B*44 lagғp(ytp|I~III&l@3333 f!$Ifgd5:kd$$Ifl\l) "  t0B*44 lagғp(ytpIIIIIIIIIIJln46οyiTi)jhEhE5CJU\aJhEhE5CJ\^JaJ)jhEhE5CJU\aJ#jhEhECJUaJU#j+hEhECJUaJhEhECJaJjhEhECJUaJhEhE5\^JaJjhECJUaJmH sH %jhECJUaJmH sH ORMCHECKBOX  No If yes, attach organic certificate  FORMCHECKBOX  Attachment If no, attach Attestation of Compliance  FORMCHECKBOX  AttachmentOther (specify)  FORMTEXT       FORMTEXT       FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMTEXT      F. TRANSPORTATION OF ORGANIC PRODUCTS1. Describe shipping containers and transport methods in the table below (check all that apply) ContainerIncomingOutgoingContainerIncomingOutgoingDry bulk FORMCHECKBOX  FORMCHECKBOX Foil bags FORMCHECKBOX  FORMCHECKBOX Liquid bulk FORMCHECKBOX  FORMCHECKBOX Wrapped pallets FORMCHECKBOX  FORMCHECKBOX Tote bags FORMCHECKBOX  FORMCHECKBOX Truck FORMCHECKBOX  FORMCHECKBOX Tote boxes FORMCHECKBOX  FORMCHECKBOX Tanker FORMCHECKBOX  FORMCHECKBOX Metal or plastic drums FORMCHECKBOX  FORMCHECKBOX Rail FORMCHECKBOX  FORMCHECKBOX Cardboard drums FORMCHECKBOX  FORMCHECKBOX Overseas container FORMCHECKBOX  FORMCHECKBOX Paper bags/boxes FORMCHECKBOX  FORMCHECKBOX Other (specify):  FORMTEXT       FORMCHECKBOX  FORMCHECKBOX Do you arrange product transport?IncomingOutgoing FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  NoHave transport companies been notified of organic handling requirements?  FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  NoPrior to loading organic ingredients/products, are transport units:Cleaned? FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  NoInspected? FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  NoCleaning/inspection documented? FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  NoAre transport units used to carry nonorganic products or prohibited substances? FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  NoIf yes, check all steps taken to prevent commingling and contamination during transport:Separate pallets FORMCHECKBOX  FORMCHECKBOX  Organic label on container FORMCHECKBOX  FORMCHECKBOX Organic product shrink wrapped/sealed in impermeable containers FORMCHECKBOX  FORMCHECKBOX Separate area in transport unit FORMCHECKBOX  FORMCHECKBOX Other (specify):  FORMTEXT       FORMCHECKBOX  FORMCHECKBOX G. TRACEABILITY 1. Describe your lot numbering system. FORMTEXT       2. Can your record keeping system track the finished product back to all ingredients?  FORMCHECKBOX  Yes  FORMCHECKBOX  No 3. Can your record keeping system balance organic ingredients in and organic products out?  FORMCHECKBOX  Yes  FORMCHECKBOX  No  OHP 7: Record Keeping CAN/CGSB-32.310, Section 4.41. Do you understand that records must disclose all activities and transactions of the operation, be maintained for 5 years, and demonstrate compliance with the Canada Organic Regime?  FORMCHECKBOX  Yes  FORMCHECKBOX  No 2. Do you understand that all relevant documents must identify products as "organic ?  FORMCHECKBOX  Yes  FORMCHECKBOX  No 3. Do you understand that all records must be available to the inspector, and CFIA representatives for inspection and copying during normal business hours?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoTo facilitate a speedy review of your organic system plan and inspection of your facility, please remember to include the following, as applicable to your operation:APPLICATION (Submit to QCS office, as applicable) FORMCHECKBOX Attachment OHP 1Driving Directions to all Locations requested for certification FORMCHECKBOX Attachment OHP 1Documentation of operation s legal status FORMCHECKBOX Attachment OHP 1Records from previous organic certification, including organic certificate, noncompliance and corrective action, denial, suspension, or cancellation of certification (as applicable) FORMCHECKBOX Attachment OHP 3Proposed labels for all finished products for which this OPP is used FORMCHECKBOX Attachment OHP 3Organic Certificate or Attestation of Compliance for each contract service provider FORMCHECKBOX Attachment OHP 3Certificate(s) from each supplier of organic ingredients and/or processing aids to include verification of relevant equivalency programs FORMCHECKBOX Attachment OHP 3For each non organic agricultural ingredient or processing aid, written verification that the product was not commercially available organically FORMCHECKBOX Attachment OHP 3Written verification from each supplier of each organic ingredient and/or processing aid was not produced with prohibited methods or materials. FORMCHECKBOX Attachment OHP 3Product Specification Sheet and product composition / ingredient statement if required for all non-organic ingredients FORMCHECKBOX Attachment OHP 4A complete written description or schematic product flow chart describing the movement of all organic products, from incoming/receiving, through production and to outgoing/shipping FORMCHECKBOX Attachment OHP 4Organic Product Profile (OPP) Sheets for each by-product FORMCHECKBOX Attachment OHP 4MSDS and/or product label for boiler additives FORMCHECKBOX Attachment OHP 5Facility pest management plan FORMCHECKBOX Attachment OHP 5Facility map showing the location of traps and monitors, and submit MSDS and/or label information for substances used for pest control FORMCHECKBOX Attachment OHP 5MSDS and /or product label for pest control substances FORMCHECKBOX Attachment OHP 6Organic integrity program, or list specific control points you have identified in your process and state how you have addressed them to protect organic integrity FORMCHECKBOX Attachment OHP 6Fraud prevention plan FORMCHECKBOX Attachment OHP 6MSDS and product label for each cleanser and sanitizer used to clean and sanitize surfaces in contact with organic products  FORMCHECKBOX Attachment OHP 6MSDS and product label for each cleanser and sanitizer that directly contacts organic products FORMCHECKBOX Attachment OHP 6Organic certificate or Attestation of Compliance for each off-site storage facility FORMCHECKBOX Attachment OHP 10Documentation from supplier s certifying agent verifying compliance with Canada-US Equivalence ArrangementINSPECTION (Make available Upon Inspection, as applicable)Incoming Records FORMCHECKBOX  Organic Certificates  FORMCHECKBOX  Transaction certificates  FORMCHECKBOX  purchase orders  FORMCHECKBOX  contracts  FORMCHECKBOX  invoices  FORMCHECKBOX  receipts  FORMCHECKBOX  bills of lading  FORMCHECKBOX  Customs forms  FORMCHECKBOX  scale tickets  FORMCHECKBOX  quality test results  FORMCHECKBOX  Certificates of Analysis  FORMCHECKBOX  receiving records  FORMCHECKBOX  receiving summary log  FORMCHECKBOX  other (specify)  FORMTEXT      In-process Records FORMCHECKBOX  equipment clean-out logs  FORMCHECKBOX  sanitation logs  FORMCHECKBOX  ingredient inspection forms  FORMCHECKBOX  blending reports  FORMCHECKBOX  production reports  FORMCHECKBOX  packaging reports  FORMCHECKBOX  QA reports  FORMCHECKBOX  other (specify) FORMTEXT      Out-going Records FORMCHECKBOX  shipping log  FORMCHECKBOX  clean truck affidavits  FORMCHECKBOX  bills of lading  FORMCHECKBOX  scale tickets  FORMCHECKBOX  purchase orders  FORMCHECKBOX  sales orders  FORMCHECKBOX  sales invoices  FORMCHECKBOX  phytosanitary certificates  FORMCHECKBOX  export declaration forms  FORMCHECKBOX  shipping summary log  FORMCHECKBOX  sales summary log  FORMCHECKBOX  audit control register  FORMCHECKBOX  complaint log  FORMCHECKBOX  other (specify)  FORMTEXT       OHP 8: QCS Certification and Mark Licensing Contract Effective on the date which Florida Certified Organic Growers and Consumers, Inc., doing business as Quality Certification Services (QCS) issues a certificate to  FORMTEXT      ___________________ (Client) under the Safe Food for Canadians Regulations Part 13 Organic Products, QCS and Client enter into this contract and agree to be bound by its provisions regarding the certification services provided by QCS and the authorized uses of the QCS certification mark and its variants. By signing this contract, Client and QCS agree to be bound by the following provisions:1. Period of Performance: This contract becomes effective on the date on which QCS issues a certificate under the Safe Food for Canadians Regulations Part 13 Organic Products to Client. The contract remains in effect until it is renewed through the execution of a new contract or is terminated or cancelled pursuant to the provisions of sections 6, 12, 13 and/or 14 of this contract.2. Canada Organic Regime (COR): The Canada Organic Regime refers to the regulatory oversight of the production of organic food commodities in Canada and includes the current Safe Food for Canadians Regulations, the Canada Organic Standards (CAN/CGSB-32.310) and Permitted Substances Lists (CAN/CGSB-32.311) and the Standards Interpretation Committee s final Q&As (official interpretations). The Safe Food for Canadians Regulations incorporates the Standards (CAN/CGSB-32.310) and Permitted Substances Lists (PSL  CAN/CGSB-32.311) by reference. The use of the term  organic in the marketing or labelling of products in the Canada is regulated by the Canadian Food Inspection Agency (CFIA). This agreement incorporates the current Safe Food for Canadians Regulations, the Canada Organic Standards (CAN/CGSB-32.310) and Permitted Substances Lists (CAN/CGSB-32.311) and the Standards Interpretation Committee s final Q&A s all future changes to the Standards as published on the CFIA website . Both QCS and Client have an independent responsibility to obtain a current copy of the Regulations, Standards, Standards Interpretation Committee s Q&As, have a copy in their possession, and understand its provisions. QCS and Client agree to abide by the Canada Organic Regime s provisions and all amendments and legally binding interpretations issued by the federal courts or the CFIA as they apply to the respective rights and duties of QCS and Client.3. Scope of Canada Organic Regime Certification by QCS: The receipt of the Canada Organic Regime Certification through QCS warrants only that client is in compliance with the requirements of the Canada Organic Regime (COR). COR Certification through QCS does not warrant compliance with any other federal, provincial, local, or international law relating to the production, handling, processing, or marketing of agricultural products or the safety of Client s practices and products. It is Client s responsibility to identify and comply with all federal, provincial, and local laws, and obtain all required permits, applicable to Client s operation. Client agrees to indemnify QCS and hold QCS harmless against any claims that may arise related to Client s failure to comply with applicable federal, provincial, local, and international laws, permits, and food safety and handling regulations Ownership of the QCS Mark and Variants: QCS has sole ownership of the QCS logo displayed in the letterhead of this contract and all variants of that logo (Marks). QCS also has sole ownership of the name Quality Certification Services, the abbreviation QCS, and the phrases  Certified Organic by Quality Certification Services,  Certified Organic by QCS,  Certified by Quality Certification Services, and  Certified by QCS, (Mark Phrases) as these phrases relate to organic certification. QCS has the exclusive right to license the use of QCS Marks and Mark Phrases to entities who have received certification by QCS and for the purpose of marketing and labelling organic products. Client does not have the right to use any of the QCS Marks or Mark Phrases except as described in section 5 of this contract. Client understands that QCS Marks and Mark Phrases are distinctive in the organic market and may not be altered or challenged in any way.Use of QCS Marks and Mark Phrases: Client may use QCS Marks and Mark Phrases in the promotion, labelling, and marketing of products listed on Client s Product Verification Form (Verification) issued by QCS in conjunction with a Canada Organic Regime certificate (Certificate). Client will not use QCS Marks or Mark Phrases in a confusing or misleading manner, or to market, label, or promote products that are not listed on Client s current Verification. Client will not use QCS Marks or Mark Phrases to mislead or confuse consumers about Client s identify, the relationship between Client and QCS, or in any manner that brings QCS into disrepute. Client will submit copies or illustrations of all labels, signs, advertisements, and other promotional materials bearing QCS Marks or Mark Phrases to QCS for approval prior to use. QCS will respond in a timely manner and will not unreasonably withhold approval if the use of the QCS Marks and Mark Phrases is consistent with the Standard and this contract. 6. Compliance with Organic System Plan: This contract is effective after QCS has reviewed the Organic System Plan (OSP) submitted by Client for compliance with the Canada Organic Regime. Client warrants that the information submitted in the OSP is complete and accurate. Upon issuance of a Certificate, QCS has determined that Client complies with the Canada Organic Regime or will be compliant after addressing all minor noncompliances issued in conjunction with the Certificate. Client will address all minor noncompliances within the timeline provided by QCS and to QCS s reasonable satisfaction. Client s operations will at all times be compliant with the OSP approved by QCS and any noncompliance resolutions approved by QCS. Client will inform QCS of any proposed changes to the OSP and will not implement those changes until approved by QCS. If Client believes that immediate changes to the OSP are necessary for safety, health, or compelling financial reasons, reasonably believes that such changes are compliant with the Standard, and assumes all risk that such changes may not be found compliant with the Standard, Client may effect the necessary changes in the OSP and inform QCS of the changes within 30 days. QCS will review the changes for compliance with the Standard. Client understands that, if said modifications to the OSP appear to violate the Standard, they will be handled in accordance with the noncompliance procedures in the Standard, including possible suspension, revocation and/or cancellation of Client s Certificate and this contract. Client has an affirmative and ongoing duty to ensure that QCS has accurate, timely, and complete information about the OSP as well as any complaints or investigations which relate to the organic integrity of its operations. Providing false, misleading, or inaccurate information to QCS is a violation of this contract and the Standard, and may lead to the imposition of civil fines as described in the Standard. 7. Fees: Client has a duty to pay all applicable certification deposits and fees in a timely fashion and in accordance with QCS written policies and procedures and the applicable provisions of the USDA Organic Regulations and/or other organic regulations. The QCS fee structure in effect on the effective date of this contract governs the fees and deposits that must be paid to QCS for the services provided in this contract. The fee schedule may change during the course of this Agreement and any changes will be communicated on the website.8. Client s Warranties and Indemnification: Client warrants that, to the best of Client s knowledge, the operations and products described in the OSP submitted and approved by QCS are compliant with all federal, provincial, and local regulations, laws, codes, and ordinances in the jurisdiction in which the OSP provides goods or services. Client acknowledges that QCS s approval of its OSP is solely a determination of Client s compliance with the Standard and is made solely for the purpose of marketing organic products or services. Client agrees to indemnify QCS, its employees, officers, owners, and subcontractors against third party claims arising from Client s operations that do not involve the Standard or the scope of certification as described in section 3 of this contract. If any portion of the Client s OSP includes areas open to the public in the normal course of business for the sale of produced, manufactured or processed goods or food, and Client maintains a liability insurance policy, Client will name QCS as an additional insured on said policy.9. Confidentiality: QCS, its agents, and its subcontractors will maintain the confidentiality of Client s confidential business information and not disclose such information without the approval of Client, except that QCS may disclose information requested pursuant to the apparent authority of a government agency or subpoena. Client will identify with particularity what information is to be considered confidential business information. General information which appears on the Certificate and Verification, as well as contact information for Client, is not considered confidential business information. QCS and Client will maintain the confidentiality of all communications between Client and QCS and the contents of any inspection report written as a result of an onsite inspection. However, Client may disclose information to its agents, parent company, or subsidiaries and/or as requested pursuant to an apparent valid authority or government agency or subpoena. 10. Subcontractors: reserves the right to use subcontractors for the performance of inspections, soil testing, product testing, and other work related to certification. All subcontractors performing inspections and other work on behalf of QCS are subject to the confidentiality provisions of section 9 of this contract.11. Accessibility: Client will make all necessary arrangements for the conduct of the evaluations and surveillance (if required), including, provision for examining documentation and access to all areas, equipment, records (including internal audit reports) and personnel for the purpose of evaluation (e.g. testing, inspection, assessment, surveillance, reassessment) and the investigation and resolution of complaints. Client will also make all necessary arrangements for the participation of observers (e.g. certification body staff, accreditation body staff, regulatory officials, trainees).12. Certificate, Privileges, and Rights Not Assignable: The Client s Certificate, the consequent privilege to use the term  organic under the Standard, and the rights granted to Client under this contract are not transferable or assignable. Any attempt by Client to assign the Certificate, its privileges, or its rights under this contract is void. 13. Renewal by Execution of New Contract: No less than 60 days prior to the annual anniversary date of the effective date of this contract, QCS will mail Client annual update forms and a new Certification and Mark Licensing Contract. If Client wishes to commit to a new contract, Client will complete all of the annual update forms provided by QCS, sign a new contract, and submit to the conditions of continuing certification described in the Standard, including a new compliance determination and onsite inspection. The new contract may contain new or different terms and provisions. If a new contract is signed by both QCS and Client, the present contract is terminated on the effective date of the new contract. If Client does not deliver the annual update forms, a signed new contract, and applicable fees and deposits to QCS prior to the anniversary of the effective date of this contract, QCS may commence noncompliance procedures as described in the Standard. Such procedures may lead to the suspension or revocation of the Certificate and cancellation of this contract.14. Termination of Contract: Client may request to terminate this contract at any time if Client has no outstanding financial obligation to QCS and no unresolved material noncompliances. Client may terminate this contract by mailing or faxing a written notice to QCS stating the following: 1) that Client wishes to surrender its Certificate; 2) that Client recognizes that it may no longer use the term  organic in the marketing or labelling of products for sale (except that an exempt or excluded operation, as described in the Standard, need not provide this statement in the notice); 3) that Client will immediately cease using the QCS Mark and Mark Phrases. In addition, Client must return the original Certificate and Verification issued to Client by QCS. If QCS reasonably determines that Client has no unresolved material noncompliances or unpaid financial obligations, QCS will accept Client s surrender of its Certificate, terminate this contract, and notify Client in writing of the termination. QCS will make this determination in a timely manner. QCS may terminate this contract based upon Client s written objection to a proposed modification of the fee structure as described in section 7 of this contract.15. Cancellation for Noncompliance: QCS may cancel this contract if Client does not comply with the Standard or the terms of this contract. Prior to cancellation of this contract and revocation or suspension of the Certificate, QCS will follow the due process provisions in the Standard, including the provision of Client with notice and the opportunity to respond, rebut, and/or correct any noncompliances. If QCS suspends or revokes Client s Certificate in accordance with the procedures provided in the Standard, this contract is cancelled on the effective date of the effective date of the suspension or revocation of the Certificate. 16. Severability: The provisions of this contract are severable; should any provision be invalidated, the remaining provisions remain in effect. 17. Governing Law and Venue: This contract is governed by the laws of the State of Florida. Client and QCS will litigate any disputes which arise between them only in the courts of the Eighth Judicial Circuit Court of Florida located in Gainesville, Florida. 18. Modification of Contract: Any modification of this contract must be in writing and agreed to in writing by both Client and QCS.19. Application to International Program. All provisions of this contract apply equally to clients who have requested one or more of the following international certification programs provided by QCS: EU 834/07 & 889/08 and/or US/Canada Equivalence Agreement. This agreement incorporates by reference all applicable regulations and legally binding interpretations of those regulations. The receipt of any international certification through QCS warrants only that client is in compliance with the applicable equivalency or export agreement. Client agrees to indemnify QCS and hold QCS harmless against any claims that may arise related to Client s failure to comply with international laws related to food production and handling.Acknowledge and Agreed to by  FORMTEXT      ________________________ Signature   FORMTEXT      ________________________ Title   FORMTEXT      ___________ Date OHP 9: Canadian/ European Union (EC) Equivalency Compliance Affirmation  Handler/ProcessorComplete this section if you are certified to the Canada Organic Regime and your product may be exported to the European Union, or your product may be used as an ingredient in organic product exported to the European Union.  FORMCHECKBOX  Not applying for this affirmationGENERALList all the organic products you wish to export to the European Union: Product NameBrand Name(s) or other ID Mark (unit size, net wt.) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      For all organic products to be sold in the EU, has the full and/or final processing and packaging of this product taken place in Canada?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If no, provide details:  FORMTEXT       Have all ingredients of these organic products either been grown in Canada or imported into Canada in accordance with SFCR Part 13 (Organic Products)  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please attach the documentation.  FORMCHECKBOX  Attachment If no, provide details:  FORMTEXT       AFFIRMATIONI affirm that all statements made in this Canadian/EU Equivalency Compliance Affirmation are true and correct.  Signature: FORMTEXT       Title: FORMTEXT       Date:  FORMTEXT       OHP 10: US/Canada Equivalency Arrangement (USCOEA) - Compliance Affirmation - Handler/Processor Complete this section if you are certified to the Canada Organic Regime and your product may be exported to the United States, or your product may be used as an ingredient in organic product exported to the United States.  FORMCHECKBOX  Not applying for this affirmationGENERALList all the organic products you wish to export to the United States: Product NameBrand Name(s) or other ID Mark (unit size, net wt.) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Are any of the products listed above produced with ingredients derived from animals? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, attach documentation from the certifier of each ingredient documenting that animals were not treated with antibiotics.  FORMCHECKBOX  Attachment Affirmation1) I affirm that all statements made in this Canada /US equivalence arrangement compliance affirmation are true and correct. No prohibited materials under the US/Canada Organic Equivalency Arrangement have been used to produce any of the organic products listed above. I agree to provide further information as required by QCS and authorized representatives of the CAEQ. 2) I agree not to put up for sale any product for which I have requested certification; and bearing the word organic or its derivatives and the QCS s mark, for as long as I have not been informed of the decision made by the QCS stating that the products are certified; 3) I agree to reveal before hand to QCS, the identity of any other company for which I intend to manufacture products under license, and thus as a result can use the QCS s mark (name and logo) on the label of the products that it intends to market under its own brand name even though it does not hold a compliance certificate for those products; 4) I agree to allow representatives from the Accreditation Advisory Bodies (CAEQ) to access during normal working hours, documentation and sites used to produce certified products, for the purposes of examination and copying within as part of QCS s assessment; 5) I agree to pay the corresponding fees requested by QCS; and 6) I agree to make all necessary arrangements for the processing of any complaints directed towards my operation. 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2 :}0 Instructions: This Organic System Plan application is designed to describe how your operation complies or plans to comply wi        2 0 th the   I2 :)0 requirements of the Canada Organic Regime       2 /0   2 20 and  2 G0   2 J 0 equivalent  2 0   p2 C0 organic standard(s). Complete all sections truthfully and accurate   2 0 ly.   2 :`0 Submit the completed application along with the Fee Payment Form and applicable fees to QCS by e        2 W0 - 2 [0 mail to  %2 0 apply@qcsinfo.org   2 0   2 0 or   2 :T0 by mail to the address listed above. Maintain a copy of the completed application f    U2 10 or your own records to ensure that the submitted    @"Arial Narrow------ 2 :u0 plan is consistent with practices on your operation. All changes that may affect compliance must be notified to QCS      --- 2  0 and approved---  2 0    2 :M0 prior to implementation, including use of new lands, inputs, or facilities. F    b2 :0 acilities and products must be approved by QCS and listed     2 :}0 on the Organic Certificate Addendum (Product Verification Form) before they are represented as organic or are used to produce      2 0    ;2 : 0 products represented as organic.  2 0     2 :0   5$3@"Arial---@"Arial---------@"Arial Narrow---@"Arial Narrow- - - ------ 2 0:3$5OHP ---  2 0[3$5 --- 2 0]3$51:A --- 2 0r 3$5PPLICATION --- 2 03$5 ---  2 03$5 - - -  %2 03$5Safe Food for Can s2 0E3$5adians Regulations, Part 13, Div. 4, Subdiv A, Application (paras 344  2 0F3$5- %2 0I3$5348) and CAN/CGSB  2 03$5- #2 03$532.310, clause 4---  2 03$5  '- @ !$2- - @ !$2- - @ !$3-  - @ !$- - @ !$-  - @ !%2-  - @ !%-  G63@"Arial Narrow- - -  ,2 B:36GA. CONTACT INFORMATION        2 B36G  '- @ !52- - @ !53-  - @ !5-  - @ !62-  - @ !6-  iG3--- +2 S:3GiLegal name of Entity:   2 S3Gi    2 d:3Gi   2 dA3Gi   2 dH3Gi   2 dO3Gi   2 dV3Gi   2 d]3Gi  'iG--- "2 SGiOperation Name:     2 SeGi    2 dGi   2 dGi   2 dGi   2 dGi   2 d#Gi   2 d*Gi  'iWG--- 2 SGWiQCS No.    2 SGWi    2 dGWi   2 dGWi   2 dGWi   2 dGWi   2 dGWi   2 dGWi  'iGX--- 2 S_XGiDate   2 SyXGi    2 d_XGi   2 dfXGi   2 dmXGi   2 dtXGi   2 d{XGi   2 dXGi  '- @ !G2- - @ !G3-  - @ !G- - @ !G-  - @ !G- - @ !G-  - @ !GW- - @ !GX-  - @ !G-  - @ !!H2-  - @ !!H-  - @ !!H-  - @ !!HW-  - @ !!H-  j3--- %2 v:3jMailing Address:   2 v3j   2 v3j   2 v3j   2 v3j   2 v3j   2 v3j   2 v3j   2 v3j   2 v3j   2 v3j   2 v3j    2 :3j    2 :3j  'j--- &2 vjPhysical Address:  j j '- -x+j- - '---  2 v-j  .2 v0jSame as mailing address    2 vj    2 j  '- @ !i2- - @ !i3-  - @ !i- - @ !i-  - @ !i- - @ !i-  - @ !iW- - @ !iX-  - @ !i-  - @ !2j2-  - @ !2j-  - @ !2j-  3@Garamond- - - --- 2 :3City: - - -   2 U3   2 ]3   2 e3   2 m3   2 u3   2 }3  ---  2 :3  '2--- 2 2State: - - -   2 2   2 2   2 2   2 2   2 2   2 2  ---  2 2  '2------ 2 9 2Zip Code:  - - -   2 q2   2 y2   2 2   2 2   2 2   2 2  ---  2 92  ' --- 2  City: - - -   2     2     2     2     2     2    ---  2    '!--- 2 '!State: - - -   2 J!   2 R!   2 Z!   2 b!   2 j!   2 q!  ---  2 '!  '--- 2  Zip Code:    2    2    2    2    2    2     2   '- @ !2- - @ !3-  - @ !- - @ !~-  - @ !1- - @ !2-  - @ !- - @ !n-  - @ ! - - @ !m!-  - @ !- - @ !n-  - @ !-  - @ !"2-  - @ !"-  - @ !"1-  - @ !"-  - @ !" -  - @ !"-  - @ !"-  3--- 2 : 3Country: - - -   2 k3   2 s3   2 {3   2 3   2 3   2 3  ---  2 :3  '--- 2  Country: - - -   2    2    2    2    2     2   ---  2   '- @ !2- - @ !3-  - @ !- - @ !~-  - @ !1- - @ !2-  - @ !- - @ !n-  - @ ! - - @ !m!-  - @ !- - @ !n-  - @ !-  - @ !"2-  - @ !"-  - @ !"-  3--- 2 :3Phone: - - -   2 c3   2 k3   2 s3   2 {3   2 3   2 3  ---  2 :3  '------ 2 Fax: - - -   2    2    2 $   2 ,   2 4   2 ;  ---  2   'W--- 2 WPhone: - - -   2 W   2 W   2 W   2 W   2 W   2  W  ---  2 W  'X--- 2 _XFax: - - -   2 zX   2 X   2 X   2 X   2 X   2 X  ---  2 _X  '- @ !2- - @ !3-  - @ !- - @ !-  - @ !- - @ !-  - @ !W- - @ !X-  - @ !-  - @ !"2-  - @ !"-  - @ !"-  - @ !"W-  - @ !"-  (3- - -  J2 :*3(CERTIFICATION CONTACTS (Authorized Represe         2 Y3(ntative)  2 3(  --- 2 #:X3(Persons listed below are authorized to communicate with QCS on behalf of this operation.      2 #3(  '- @ !2- - @ !3-  - @ !- - @ !-  - @ !- - @ !-  - @ !W- - @ !X-  - @ !-  - @ !"2-  - @ !"-  J(3- - - - - -  2 4:3(JName  ---  2 4\3(J  'J(- - - - - -  &2 4(JRole in Operation  --- 2 4c(J(Owner,   --- .2 E(JManager, Billing, etc.) - - -   2 Eo(J ---  2 Eq(J  'JW(- - - - - -  2 4(WJPhone---  2 4(WJ  'J(X- - - - - -   2 4_X(JE  2 4gX(J- 2 4kX(Jmail ---  2 4X(J  '- @ !(2- - @ !(3-  - @ !(- - @ !(-  - @ !(- - @ !(-  - @ !(W- - @ !(X-  - @ !(-  - @ !!)2-  - @ !!)-  - @ !!)-  - @ !!)W-  - @ !!)-  lK3- - -   2 W:3Kl   2 WB3Kl   2 WJ3Kl   2 WR3Kl   2 WZ3Kl   2 Wb3Kl  ---  2 g:3Kl  'lK- - -   2 WKl   2 WKl   2 W Kl   2 WKl   2 WKl   2 W!Kl  ---  2 gKl  'lWK- - -   2 WKWl   2 WKWl   2 WKWl   2 WKWl   2 WKWl   2 WKWl  ---  2 gKWl  'lKX- - -   2 W_XKl   2 WgXKl   2 WoXKl   2 WwXKl   2 WXKl   2 WXKl  ---  2 g_XKl  '- @ !J2- - @ !J3-  - @ !J- - @ !J-  - @ !J- - @ !J-  - @ !JW- - @ !JX-  - @ !J-  - @ !!K2-  - @ !!K-  - @ !!K-  - @ !!KW-  - @ !!K-  m3- - -   2 y:3m   2 yB3m   2 yJ3m   2 yR3m   2 yZ3m   2 yb3m  ---  2 :3m  'm- - -   2 ym   2 ym   2 y m   2 ym   2 ym   2 y!m  ---  2 m  'Wm- - -   2 ymW   2 ymW   2 ymW   2 ymW   2 ymW   2 ymW  ---  2 mW  'mX- - -   2 y_Xm   2 ygXm   2 yoXm   2 ywXm   2 yXm   2 yXm  ---  2 _Xm  '- @ !l2- - @ !l3-  - @ !l- - @ !l-  - @ !l- - @ !l-  - @ !lW- - @ !lX-  - @ !l-  - @ !!m2-  - @ !!m-  - @ !!m-  - @ !!mW-  - @ !!m-  3- - -   2 :3   2 B3   2 J3   2 R3   2 Z3   2 b3  ---  2 :3  '- - -   2    2    2     2    2    2 !  ---  2   'W- - -   2 W   2 W   2 W   2 W   2 W   2 W  ---  2 W  'X- - -   2 _X   2 gX   2 oX   2 wX   2 X   2 X  ---  2 _X  '- @ !2- - @ !3-  - @ !- - @ !-  - @ !- - @ !-  - @ !W- - @ !X-  - @ !-  - @ !!2-  - @ !!-  - @ !!-  - @ !!W-  - @ !!-  3- - -   2 :3   2 B3   2 J3   2 R3   2 Z3   2 b3    2 :3  '- - -   2    2    2     2    2    2 !    2   'W- - -   2 W   2 W   2 W   2 W   2 W   2 W    2 W  'X- - -   2 _X   2 gX   2 oX   2 wX   2 X   2 X    2 _X  '- @ !2- - @ !3-  - @ !- - @ !-  - @ !- - @ !-  - @ !W- - @ !X-  - @ !-  - @ !!2-  - @ !!-  - @ !!-  - @ !!W-  - @ !!-  3- - - - - -  2 :3ADD  G2 U(3ITIONAL COPIES OF ORGANIC CERTIFICATE          3--- 3 '--qc- -'--- 2 s3 - - -  2 z3None   2 3  --- 2 :}3Provide the name(s) and contact information for any additional person(s) that should receive a copy of your organic certifica   2 3te:- - -   2 3  '- @ !2- - @ !3-  - @ !- - @ !-  - @ !- - @ !-  - @ !W- - @ !X-  - @ !-  - @ !!2-  - @ !!-  3- - - - - -  ,2 :3CONSULTANTS    3--- 3 '--- -'--- 2 3 - - -  )2 3Not Applicable (not   (2 E3using a consultant)  2 3  --- 2 :n3(Please note that it is your responsibility to update QCS of any modifications to the consultant information).   - - -   2 s3  '- @ !2- - @ !3-  - @ !-  - @ !!2-  - @ !!-  9!3--- 2 #:3!9Name:  - - -   2 #a3!9   2 #i3!9   2 #q3!9   2 #y3!9   2 #3!9   2 #3!9  - - -   2 4:3!9  '9!--- 2 #(!9Phone: - - -   2 #Q!9   2 #Y!9   2 #a!9   2 #i!9   2 #q!9   2 #y!9  - - -   2 4(!9  '9---  2 #9E  2 #9- 2 #"9mail: - - -   2 #?9   2 #G9   2 #O9   2 #W9   2 #_9   2 #f9  - - -   2 49  '- @ !#2-    - @ !#-  [93------ d2 F:;39[How would you like QCS to communicate with the consultant? 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