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New Mexico Department of Agriculture, Organic Program 2016 APPLICATION FOR ORGANIC CERTIFICATION – PROCESSOR / HANDLER

BUSINESS NAME: COUNTY:

OWNER’S NAME: PHONE NUMBER:

TITLE:

CONTACT NAME (IF DIFFERENT FROM ABOVE):

PHONE NUMBER:

TITLE:

FOREMAN/ MANAGER (IF DIFFERENT FROM ABOVE):

PHONE NUMBER:

TITLE:

MAILING ADDRESS :

CITY: STATE: ZIP CODE:

PHYSICAL ADDRESS/ LOCATION OF FACILITY:

CELL PHONE NUMBER (IF DIFFERENT FROM ABOVE):

ALTERNATE PHONE NUMBER:

FAX NUMBER:

EMAIL ADDRESS:

WEBSITE:

BUSINESS INFORMATION : INDIVIDUAL (SOLE PROPRIETORSHIP) INDIVIDUAL “DOING BUSINESS AS” CORPORATION

LIMITED LIABILITY COMPANY (LLC)

EDUCATIONAL INSTITUTION / PUBLIC INSTITUTION / NONPROFIT

GENERAL PARTNERSHIP

COOPERATIVE

OTHER: (PLEASE LIST)

2016 NMDA Organic Processor/Handler Application – [email protected] of 24

mailto:[email protected]

New Mexico Department of Agriculture, Organic Program AFFIRMATION OF ORGANIC APPLICANT

I, as an authorized representative of [Business Name] depose and say

that I will:

1. Fully comply with all applicable organic production and handling regulations in accordance with Title 7 CFR Part 205 National Organic Program Rule.

2. Establish, implement, and update annually an organic production or handling system plan that will be submitted to New Mexico Department of Agriculture (NMDA).

3. Supply NMDA with all information required to verify compliance with the National Organic Program Rule.

4. Permit on-site inspections with complete access to the production or handling operation, including noncertified production and handling areas, structures, and offices by NMDA inspectors. These inspections may be announced or unannounced at the discretion of NMDA or as required by the Administrator of the National Organic Program.

5. Maintain all records applicable to the organic operation for not less than five (5) years beyond their creation.

6. Allow authorized representatives of NMDA, or the US Secretary of Agriculture access to these records under normal business hours for review and copying to determine compliance with the National Organic Program Rule.

7. Submit to NMDA the applicable fees as described on the fee schedule which is current at time of payment.

8. Immediately notify NMDA about any application, including drift, of a prohibited substance to any field, production unit, site, facility, livestock, or part of an operation.

9. Immediately notify NMDA of any change in our certified operation or portion of it that may affect its compliance with the National Organic Program Rule, including: additions or deletions of crops & fields, new inputs (fertilizers, pest control, processing aids, etc.); facilities; ingredients & products; changes to managers or responsible parties; contact information and email address.

10. Understand that willful violation of organic rules and regulations may result in revoking of organic certification and in extreme cases may lead to state and federal fines and penalties.

11. Understand that submitting this application in no way implies granting of certification by NMDA.

12. Understand that this form becomes a legally binding document upon submission by NMDA.

SIGNATURE OF AUTHORIZED REPRESENTATIVE: DATE:

PRINT NAME TITLE:



New Mexico Department of Agriculture, Organic Program If you were Certified Organic in 2015, please report your

2015 ORGANIC SALES & PRODUCTION● Sales include distributors, grocery stores, internet, farmer’s markets, restaurants, etc.● Please list by general product type (milk, nuts, nut butters, herbs, lip balm, body oil, pasta, tortillas, breads, etc.)

Organic Product

Production SalesTotal of Unique

Brand Name Products

All Unit Sizes (pounds, ounces, supersacks, etc)

Wholesale Sales(rounded to nearest

dollar)

Retail Sales(rounded to nearest

dollar)

Total Certified Organic Sales 2015

Percentage of Sales

Type of Sales Number of Employees

Type of Employee

% Farmers Markets Permanent Full Time Employees% On-Farm Sales Permanent Part Time Employees% CSA (Community Supported Agriculture) Seasonal Employees% Wholesale

Marketing & Jobs - Help us show the importance of organic farming in New

Mexico’s economy.

% Restaurant% Retail Stores% Other:

Please specify



Organic Product Summary – Processor /Handler

A. Organic Product Composition and labeling § 205.301 – 305● Product Profile & Label Proof for each product must be approved before organic certification. Submit label proofs for approval before printing. NMDA is NOT responsible or liable for non-compliant or incorrect labels.

● If any changes are made to a formula, an updated Product Profile must be submitted before production.

● The statement “Certified Organic by New Mexico Department of Agriculture” must appear on the label immediately below the contact information of the handler or distributor of the product.

● Labels must identify each organic ingredient in the ingredient statement with the word, “organic,” or with an asterisk or other reference mark which is defined to indicate the ingredient is organically produced.

● Use of Organic Seal is optional. You may use the either NMDA Organic Seal or the USDA Organic Seal, or both. The NMDA Organic Seal may not be displayed more prominently than the USDA Organic Seal.

● Products must carry a tracking /date code that can be used to trace your production dates & records.

● Ingredients must not be produced using excluded methods (GMOs), sewage sludge, or ionizing radiation.

● Salt & water are excluded from the calculations but must be free of prohibited additives.

● “Organic “ and “100% Organic” products may not contain non-organic processing aids, flavors, colors or ingredients unless they appear on the National List of Allowed Substances NOP § 205.605-606.

● You may not sell new products (products not certified organic in 2015) as organic until they appear on your 2016 Organic Product List.

PLEASE LIST ALL OF YOUR ORGANIC PRODUCTS BELOWProducts labeled “ORGANIC” must contain at least 95% organic ingredients. All other ingredients and processing aids must be on the National List: § 205.600 -606.

none

New product in

2016?

List all sizes of this product

Product Name exactly as it appears on the label




Products labeled “100% ORGANIC” must contain only ingredients that are Certified 100% Organic, including processing aids.

None

New product in

2016?



Products labeled “MADE WITH ORGANIC (SPECIFIED INGREDIENTS OR FOOD GROUPS)” must contain at least 70% organic ingredients and may use the phrase, “made with organic (specified ingredients or food groups),” to modify the name of the product in retail display, labeling, and display containers. Statement must not list more than three organic ingredients or food groups.

None

New product in

2016?



Products with less than 70% organic ingredients Organic ingredients may ONLY be identified in the ingredient statement. The word “organic” may not appear elsewhere on the label

none

New product in

2016?






B. INGREDIENT VERIFICATION

1. How do you verify that ingredients or products you receive were certified organic according to the National Organic Program?

Obtain current organic certificates from suppliers

Obtain current organic product lists from suppliers

Other (please specify):

2. How often are organic certificates obtained?

Upon receipt of organic ingredients or products Yearly Other (please specify):

3. How do you prevent the use of non-organic ingredients or processing aids that have been produced using genetically modified organisms (GMOs), sewage sludge, or ionizing radiation? Please check all that apply.

Not applicable, only using certified organic ingredients, products, or processing aids GMO testing

Letters from manufacturer


3a. How often does your company obtain updated non-GMO, non-sewage sludge, and non-ionizing radiation documentation?

4. How do you verify that products handled by your company are free of prohibited processing aids?

Not Applicable, no processing aids used

Letters from manufacturers Other (please specify):




5. Are sulfites, nitrates, or nitrites added during the handling or processing or organic products at your facility? Yes No

6. If salt is used in your products, do you have verification that the salt is free from prohibited flowing agents or other prohibited materials?

Yes No N/A



PRODUCT PROFILE Complete one form for each organic product.

BUSINESS NAME:

PRODUCT NAME exactly as it appears on the label.

Product Labeling Category: 100% Organic (every ingredient is Certified 100% Organic) Organic (contains at least 95% Certified Organic ingredients) Made with organic ingredients ( contains 70-95% Certified Organic Ingredients)

INGREDIENTS Have you verified () that nonorganic ingredients are not produced with any of

the following:Ingredient(Include Additives)

Supplier/ManufacturerIf more than one supplier for same

ingredient, list both separately

Organic()

Certifying Agency of Organic Ingredient

Weight or

Volume% of

FinishedProductExcluded

Methods (GMOs)

SewageSludge

IonizingRadiation

A. Weight of Organic Ingredients: B. Total Weight of Formula:

(Excluding water and salt)C. Percent of Organic Ingredients: (A ÷ B) x 100

PROCESSING AIDS: (1) Substance added to a food during processing but is removed in some manner before the food is packaged in its finished form (2) substance added to a food during processing, is converted into constituents normally present in the food, and does not significantly increase amount of the constituents naturally found in the food; and (3) substance added to a food for its technical or functional effect in the processing but is present in the finished food at insignificant levels and does not have any technical or functional effect in that food.

Processing Aid Organic Non-Organic

Is the processing aid on the National List (205.605)? Supplier/Manufacturer Name Application & Use

yes no yes no



ORGANIC SYSTEM PLAN – PROCESSOR/HANDLER

SECTION C. GENERAL INFORMATION § 205.201 , 205.401National Organic Standards 7 CFR 205 require an organic system plan that is verified and approved by an accredited certifying agent. A certified operation must update this system plan on an annual basis in order to verify continued compliance. Please remember that your plan may change. Changes or updates must be approved by NMDA prior to implementation. Submit changes and updates by email, letter or fax. Keep copies of all applications, forms and documents you submit to NMDA. Organic recordkeeping forms are available at https://attra.ncat.org/organic.html

COMPANY OVERVIEW

1. Please provide a description of your operation and facilities:

2. Please provide detailed directions to your operation/facility:

3. Does your business also process/handle non-organic products? Yes No

CERTIFICATION SUMMARY

4. Have you ever previously applied for organic certification?

4a. If “Yes,” please list the year(s) and certifying agency to which you applied.

Yes No

5. Are you currently certified organic or have you ever been certified organic? Yes No

5a. If “Yes,” please list the name of the certifying agency and the year(s) certified by that agency.

6. Have you ever been denied certification or had your certification suspended or revoked? Yes No

6a. If “Yes,” please list the name of the certifying agency, the year(s) and describe the circumstances. Please attach copies of Notice of Denial of Certification and/or Notice of Noncompliance; description and evidence of your corrective actions.

7. If currently certified by NMDA, were issues noted or has information been requested that is still outstanding? (see your last correspondence from NMDA) Yes No N/A

7a. If “Yes,” please note conditions or information requested and how you have resolved the issue.

2016 NMDA Organic Processor/Handler Application – [email protected] Page 8 of 24



8. Which other agencies inspect/audit your facility? Please specify which agency/organization:

state/local

health/food safety.

independent (AIB, Fair Trade, etc.)

other

SECTION D. CHAIN OF CUSTODY

1. Please indicate which handling categories apply to this facility and your company. Please check all that apply.

Processor of multi-ingredient products

Processor of single-ingredient products

Packer of raw agriculture products

Wholesale Grocery Distributor

Warehouse/Storage Facility

Re-pack of previously packaged and/or

processed products

Marketing Company

Brokerage


2. What specific type of handling or processing occurs at this facility (i.e. baking, milling, canning, grain cleaning, repacking etc.)?

3. Does your company own the organic products that are handled at this facility? Yes No Both3a. If “Yes,” at what point do you take ownership the ingredients or products handled at your facility?

4. Organic & Non-Organic percentage of annual production : % Organic

% Non-Organic

5. Do you handle or process (or plan to) the same product in both organic & non-organic form? Yes No 5a. If “Yes,” please provide a list of the products that you handle or process in both an organic and non-organic form.

Please attach a separate sheet of paper if necessary.




PRIVATE LABELING

6. Do you plan to custom process or custom label organic products for other companies? Yes No 6a. If “Yes,” please complete the table below listing the company or companies that you plan to custom label or custom process for. Please attach a separate sheet of paper if necessary.

Company Name Product Name (exactly as appears on label)

Is the contracting company certified

organic?

If yes, please identify the certification agency to be listed

on the label.

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

SUB-CONTRACTS7. Do you plan to contract with any farms or other facilities to produce, process, store, or label

organic products? Yes No

7a. If “Yes,” please complete the table below. Please attach a separate sheet of paper if necessary.

Contracted Farm or Company Contact InfoCertifier of the

Contracting Company

8. Is your company responsible for sourcing the ingredients for the organic products processed at your facility? Yes No

8a. If “No,” please identify the responsible party or parties.

9. Please indicate how organic products handled or processed by your company are marketed. Please check all that apply.

Bulk Sales to Food Processors

Retail or Bulk Sales to Food Distributors or Retail Stores

Direct Sales to Consumers

Export to EU

Export to Japan/Taiwan

Export to Canada

Other (specify):




SECTION E. HARVEST AND TRANSPORTATION OF ORGANIC CROPS § 205.103, 205.270, 205.272

1. Does your company arrange for, or is your company responsible for, the HARVEST of organic crops? Yes No

If “No,” move onto question #2.

1a. If “Yes,” how do you ensure there are no non-organic crop residues in harvest equipment?

Equipment used for organic crops only Equipment is cleaned prior to organic crop harvest or use

1b. Is harvest equipment cleaning documented? Yes No

1c. If “Yes,” please indicate what type of cleaning documentation is maintained.

Clean truck/equipment affidavits Clean out records Other (please specify):

2. Does your company arrange for, or is your company responsible for, the TRANSPORTATION of organic crops? Yes No

If “No,” move onto question #3. 2a. If “Yes,” how do you ensure there are no non-organic crop residues in transport equipment?

Equipment used for organic crops only Equipment is cleaned prior to organic crop harvest or use

2b. Is transport equipment cleaning documented? Yes No

2c. If “Yes,” please indicate what type of cleaning documentation is maintained.

Clean truck/equipment affidavits Clean out records Other (please specify):

3. Does your company provide HARVEST CONTAINERS to farms for organic products? Yes No

If “No,” move onto Section D – Receiving – Incoming Organic Products.

3a. If “Yes,” describe them:

Are the containers New Used for organic crops only Cleaned prior to use Lined prior to use

3b. How are harvest containers identified/labeled as “organic”?

SECTION F. RECEIVING – INCOMING ORGANIC PRODUCTS § NOP 205.103, 205.270, 205.272

1. How are organic products received at your facility? Please check all that apply.

Bins

Bulk trailer

Bulk bags

Totes

Drums

Wholesale boxes

Retail packages


2. What receiving/shipping documents accompany incoming organic products? Please check all that apply.

Organic Certificate/Product Lists

Transaction Certificate

Field ticket

Clean truck/equipment affidavits

Invoice

Purchase order

Bill of lading

Scale ticket

Contracts

Certificates of analysis





3. How are products identified as “organic” on your internal receiving documents?

4. Do you assign an internal lot code at the time of receipt of ingredients/products? Yes No

4a. If “Yes,” please describe the lot code system.

5.6. Please describe how your company ensures incoming organic ingredients/products are protected from contamination by prohibited

substances and commingling with non-organic ingredients/products.

SECTION G. CLEANING, SANITATION § 205.103, 205.270, 205.272Handling practices and procedures must present no contamination risk to organic ingredients and products from commingling with non-organic products or contact with prohibited substances. Procedures used to maintain organic integrity must be documented.

1. Check all cleaning methods used prior to processing or handling organic products.

No Cleaning or Purging Occurs - Move onto Section F – Packing-Processing

Sweeping

Scraping

Vacuuming

Soap and water

Compressed air

Manual washing

Clean in place (CIP)

Purging of equipment

Steam cleaning

Sanitizing


2. Please list all cleaning / sanitation materials used on food contact equipment / surfaces. None Used (skip to question #7)

Cleanser / Sanitizer On which equipment or surface?Used prior to organic

handling or processing?

Frequency of Use

Check if cleaning is documented.




3. Is the use of cleansers/sanitizers followed by a potable water rinse? Yes No

4. Does your facility test food contact surfaces or rinsate water for cleaner/sanitizer residues? Yes No

5. Are Quaternary Ammonia products used prior to processing and/or handling organic products? Yes No

5a. If “Yes,” what steps are taken to prevent contamination of organic food?

Quaternary Ammonia is designed to leave residuals on surfaces. If Quaternary Ammonia is used at your facility: (a) you must prevent contamination of organic ingredients and products; and (b) NMDA requires residue testing for Quaternary

Ammonia. 6. Please describe how your operation ensures organic products are not contaminated by a cleansers/sanitizers.

7. Is equipment purged prior to handling or processing organic products? Yes No

7a. If “Yes,” please describe purge procedures, quantities purged, documentation of purge and disposition of purged ingredients.

8. Please describe how your operation documents and records ALL cleaning, sanitation, and/or purge practices and procedures.

SECTION H. PACKING, PROCESSING § 205.103, 205.270, 205.272

1. Which types of production records are kept?

Equipment clean-out logs

Product specification sheet

Ingredient inspection forms

Ingredient inventory

Batch logs

Ingredient usage reports

Production log

Shift production log

QC reports

Waste log

Shrinkage log

Ingredient inventory reports

Finished product inventory reports

Packaging reports


2. Are products identified as “organic” on production documents?




3. Are your packing or processing lines and/or equipment dedicated for use with organic products only? Yes No

3a. If “No,” please describe how you ensure organic products are not contaminated with prohibited materials or commingled with non-organic products during packing and/or processing.

4. How are partial pallets/boxes/drums of organic products handled and how does your company ensure they are protected from commingling with non-organic products during packing or processing? N/A

SECTION I. POST-HARVEST MATERIALS § 205.272, 205.601A post-harvest material is a substance that is used on a raw organic crop prior to packaging or processing of the crop. In order to use a post-harvest material on an organic crop product, the material must be an approved agricultural product or must be listed in section § 205.601 of the National List.

1.2. 3. Please indicate what type(s) of post-harvest materials are at your facility. Check all that apply.

NONE USED – Move onto Section H – Processing Aids

Waxes

Floatation Agents

Anti-foaming agents

Anti-Microbial Agents

Anti-Fungal Agents

Sprouting Inhibitors

Sanitizers


2. Please list all post-harvest materials used at your facility in the table below. Please be sure to indicate which materials are used with organic products. Please attach a separate sheet of paper if necessary.

Used with organic

products?Post-harvest Material What is its function? Source / Contact

Is the substance on the NOP

National List? Yes No Yes No Yes No Yes No Yes No Yes No Yes No




SECTION J. PROCESSING AIDS § 205.272, 205.605-205.606A processing aid is defined as (a) substance that is added to a food during processing, but is removed in some manner from the food before it is packaged in its finished form; (b) a substance that is added to a food during processing, is converted into constituents normally present in the food, and does not significantly increase the amount of the constituents naturally found in the food; and (c) a substance that is added to a food for its technical or functional effect in the processing, but is present in the finished food at insignificant levels and does not have any technical or functional effect in that food.

To use a processing aid in an organic product labeled as “100% Organic” the processing aid must be Certified 100% Organic.

To use a processing aid in or on an organic product labeled as “organic,” or “made with organic (specific ingredients or food groups),” the processing aid must be an approved agricultural product or must be listed in section 205.605 of the National List.

1. Please indicate what types of Processing Aids are used in the manufacturing of products at your facility. Check all that apply.

NONE USED – Move onto Section I - Water Anti-sticking or release agents

Enzymes

Filtering agent

Anti-caking agent


2. Please list ALL processing aids used at your facility. Please indicate which materials are used with which organic products. Please attach a separate sheet of paper if necessary.

Processing Aid(Brand Name)

Used on which product? What is its function?Source of aid and

contact informationOn the

National List?

Certified Organic

?

SECTION K. WATER § 205.103, 205.272, 205.601, 205.605

1. How is water used at your facility? NOT USED – Move onto Section J - Storage

Ingredient

Cooking

Steam

Product transport (fruit floating, etc.)

Cleaning organic products

Cooling

Cleaning equipment

Other (please specify)

2. Source of water: Municipal On-site well Other (please specify):

3. Does the water meet the Safe Drinking Water Act? Yes No

4. Is water treated on-site? Yes No




4a. If “Yes,” please indicate what water treatment processes are used.

5. Do you use municipal water? Yes No 5a. If “No”, please describe source.

5b. If “No”, please describe how you monitor water quality.

6. Is bleach, chlorine, calcium hypochlorite, chlorine dioxide, or sodium hypochlorite used for disinfecting and sanitizing food contact surfaces at your facility?

Yes No

6a. If “Yes”, how do you test chlorine levels to ensure levels do not exceed the maximum residual disinfectant limit under the Safe Drinking Water Act (4ppm)?

Chlorine /bleach testing frequency: Daily Weekly Monthly Annually Other (please specify):

6b. Please describe how you document the results of your monitoring or testing.

7. Is steam used in the processing or packaging of food products? Yes No

7a. If “No,” move onto to Section J - Storage.

7b. If “Yes,” does steam have direct contact with organic food products? Yes No

7c. If “Yes,” which of the following do you use?

Steam filters Condensate traps Testing of condensate Testing of finished products Other

7d. Are boiler water additives used during food handling or processing? Yes No

7e. If “No,” move onto to Section J – Storage.

7f. If “Yes,” please list all products used as boiler additives in the table below. Please indicate which boiler water additives will be used during handling or processing of organic food products.

Name of Boiler Water AdditiveUsed During

Organic Handling or Processing?

Source Name and Phone #Is it on the National

List?

Attach MSDS and/or label information for boiler additives you plan to use during organic handling or processing.

8. If boiler water additives are used during organic processing, please indicate how you use them and how organic integrity is maintained.




SECTION L. STORAGE § 205.270, 205.272

1. Does your company store organic products?

If “No,” move onto Section K – Packaging and Shipping Containers Yes No

1a. If “Yes,” please provide details:

Use Location and Name/Number of Storage Area(s)

Off Site?* Type

(bin, bay, etc.)Capacity

Storage Unit

Dedicated Organic?yes no

Incoming Raw Product Storage

Ingredient Storage

Packaging Material Storage

In-process Storage

Finished Product Storage

Other (Please specify):

Other (Please specify):

* Off Site storage name, location and contact:

5. Please describe how you ensure organic products are not contaminated with prohibited materials or commingled with non-organic products at ALL storage locations.




SECTION M. PACKAGING AND SHIPPING CONTAINERS § 205.270, 205.272

Practices and procedures must present no contamination risk from commingling with non-organic ingredients/products or contact with prohibited substances. Packaging materials, bins, and storage containers must not contain any synthetic fungicides, any preservative, or any fumigants. Reusable bags or containers must be cleaned if they have been in direct contact with prohibited substances or non-organic ingredient/product. Procedures used to maintain the organic integrity of ingredients or products must be documented.

1. Does this facility pack organic products into retail packages or place organic products in storage or shipping containers?

Yes No

1a. If “No,” move onto Section L – Shipping-Outgoing Products. If “Yes,” what type(s) of packaging materials or storage/shipping containers do you use? Please check all that apply.

Paper Cardboard Wood Plastic Glass Metal Foil Waxed paper Poly


2. Are all packaging materials and/or storage and shipping containers food grade? Yes No

3. Have any packaging and/or storage and shipping containers been exposed to synthetic fungicides, preservatives, or fumigants?

Yes No

4. Are packaging materials and/or storage and shipping containers reused? Yes No

4a. If “Yes,” please describe how organic ingredients/products are protected from contamination when placed in the reused container.

5. Please describe how you identify packages or containers as organic (signage, lot numbers, etc.)

6. Is all packaging and labeling equipment cleared of organic identification prior to all subsequent conventional runs?

Yes No N/A

SECTION N. SHIPPING – OUTGOING ORGANIC PRODUCTS § 205.103, 205.270, 205.272

1. How do organic products leave your facility? Please check all that apply.

Bins Bulk trailer Drums Bulk bags Totes Wholesale boxes Retail packages

Other (specify):

2. Please indicate what shipping or sales documents are maintained by your company. Please check all that apply.

Pallet/tote ticket Bill of lading Sales invoice Clean truck affidavit Purchase order Scale ticket

Contracts Other (please specify):




3. Do all documents clearly identify products as organic? Yes No

4. Does your company arrange outgoing product transport? Yes No

4a. If “No,” move onto Section M. Pest Management

4b. If “Yes,” have transport companies been notified of organic handling requirements? Yes No

5. How does your company ensure outgoing transport units are cleaned prior to loading loose, bulk organic products?

Not Applicable, only packaged products are shipped

Clean truck/equipment affidavits

Clean out records

Other (please specify

6. Are organic products shipped in the same transport units as non-organic products? Yes No

6a. If “Yes,” please indicate what steps are taken to segregate organic products.

Use of separate pallets

Organic product shrink wrapped

Separate area in transport unit

Organic product sealed in impermeable containers


SECTION O. PEST MANAGEMENT § 205.271● Pest management practices begin with the removal of pest habitat, food sources and breeding areas, and prevention of access to the facility. Environmental factors such as temperature, light, humidity, atmosphere, and air circulation may also be used to prevent pests. Control of pests may be accomplished by mechanical or physical controls including, but not limited to, traps, light, sound, or lures and repellants that use non-synthetic or synthetic substances consistent with the National List § 205.605-606. ● If these measures are not effective, a synthetic substance on the National List may be used, provided the certifying agent approves use of the substance, method of application, and measures taken to prevent contact with ingredients or organic products. Use of pest control products must be documented and included as part of the organic system plan.

1. What type of pest management system does your facility use? N/A

In-house: Name of responsible person:

If in-house please complete the Pest Control Materials Table on following page.

Contract pest control service: Name, contact info:

If contract pest control service, please attach a copy of contractor’s current report which specifies pest control materials applied & location.

2. Check all pest problems at your facility.




No pest problems Crawling insects Flying insects Rodents Birds


3. Check all pest management practices used at your facility.

Good sanitation

Removal of exterior habitat/food

Clean up spilled product

Sealed doors and/or windows

Repair of holes/cracks

Screened windows/vents

Physical barriers

Air curtains

Monitoring

Incoming ingredient inspection

Ultrasound/light devices

Release of beneficials

Sticky traps

Electrocutors

Pheromone traps

Mechanical traps

Freezing treatments

Heat treatments

Vitamin baits

Fumigation* Fogging* Sprays-- crack, crevice, perimeter, etc* Other

* The use, frequency, and method of application of all pest controls -- especially fumigants, fogs and sprays ---must be approved by NMDA. Please explain how organic ingredients, products and organic product packaging are protected from exposure to these substances at your facility.

Pest Control Materials applied in-house

Material & Brand NamePlease be specific Purpose

Is this material OMRI Listed?

http://www.omri.org/omri-lists

Yes Noexample: Evergreen Pyrethrum Concentrate crawling insects X




SECTION P. QUALITY ASSURANCE § 205.103, 205.270, 205.272 A certified operation must maintain records regarding the handling of organic products. These records must be adapted to the particular business or operation, must fully disclose all activities and transactions of the certified operation in sufficient detail to be readily understood and audited, must be maintained for five years, and must be sufficient to demonstrate compliance with NOP Rule.

1. Do you have standard operating procedures for organic processing and/or handling? If “Yes,” please attach a copy.

Yes No

2. Do you have a Quality Assurance program in place?

2a. If “Yes,” please indicate what type of program.

ISO HACCP Total Quality Management GAPS Other (please specify)

Yes No

Section O. RECORDKEEPING § 205.103 National Organic Standards require organic producers to maintain records concerning the production and handling of organic products. These records must fully disclose all activities and transactions of the operation in sufficient detail to be readily understandable and auditable and must be available for inspection and copying. You are required to maintain records related to organic production for 5 years and have them available during inspections. Records include but are not limited to product formulas/profiles, labels, facility maps/flow chart, ingredient organic certificates/ purchases/receiving, production/batching records, residue testing, shipping/transportation logs, storage/inventory records, sales.

1. Be prepared to submit copies of all records requested by NMDA.

2. Be prepared to produce all records requested by your inspector at the time of inspection.

Organic recordkeeping forms are available at https://attra.ncat.org/organic.html

SECTION Q. MAP & PRODUCT FLOW see page 22 § 205.270, 205.272

Please attach a FACILITY MAP/ DIAGRAM and a FLOW CHART for each different processing and/or handling line at your facility.

The flow chart(s) must:

Show the movement of all organic products, from incoming/receiving through production to outgoing/shipping.

Indicate where ingredients are blended, added, etc.

Indicate all equipment and storage areas associated with organic products.



Updated maps are required EACH year; use this form or equivalent

SUBMIT MAP/DIAGRAM of your facility that includes a complete floor plan :(1) all locations and buildings (2) rooms & their usage(3) processing machinery/equipment (ovens, mixers, etc.) (4) storage (coolers, freezers, dry storage, etc. of ingredients, cleaning materials, pest control materials, etc.) (5) receiving (6) staging (7) shipping (8) total square footage.

Attachment (Check if map/diagram is attached rather than detailed below)



New Mexico Department of Agriculture, Organic Program

BUSINESS NAME:

OWNER NAME:

FEE SCHEDULE part 1 of 2

ASSESSMENT FEE is three-fourths of one percent (¾ percent) of the first million dollars of gross organic sales,plus seventy-five one thousandths of one percent of the gross organic sales over one million dollars.

Total Gross Certified Organic Sales for the 2015 Calendar Year (Jan. 1, 2015 – Dec. 31, 2015) rounded to the nearest dollar

A: $

$0 to $1,000,000 (one million)

For sales between zero and the first one million dollars, multiply Box A amount by .0075

B: $

Are gross organic sales over one million dollars? Yes No If “No”, enter amount from box B into box D

If “Yes”, your total assessment is the sum of the assessment on your first one million dollars (box B), plus the assessment on sales over your first one million dollars (box C).

Over $1,000,000 (one million)

For sales over one million dollars, multiply the amount over one million by .00075

C: $

Total Organic Sales Assessment Fee (the sum of box B & C) =D: $

LATE FEE - for RENEWAL applications postmarked after April 1, 2016

Late Fee: renewals received after April 1, 2016 $75.00Late fees apply to

RENEWAL applicants only.

Late Fee: renewals received after May 1, 2016 $100.00

Late Fee: renewals received after June 1, 2016 $200.00

Late Fee: renewals received after July 1, 2016 $500.00

Total Late Fees = E :




PROCEED TO NEXT PAGE TO COMPLETE APPLICATION FEE TOTALS

FEE SCHEDULE part 2 of 2

APPLICATION FEE

RENEWAL Application Fee $200.00 ORNEW Applicants Fee (first time ) $250.00

Renewal applicants only

New applicants only

Late Fee Renewal applicants ONLY (see box E from page A above) Applies to renewal applications

postmarked after April 1, 2016

Total Organic Sales Assessment Fee (see box D from page A above) Does not apply to new applicants

FEES ARE NOT REFUNDABLE Total Fees = F: CHECKS PAYABLE TO “NMDA”

PLEASE NOTE: If new or additional fields/products are added after the annual inspection is complete, additional costs will be incurred. A cost estimate will be provided.

● If a second inspection is necessary you will be billed for the actual cost of the inspection and the actual cost of the office audit ($40/hr) to complete the addition.

●In cases where no second inspection is required, you will be billed for the actual cost of the desk audit ($40/hr).

● Payment must be received before the new or additional fields/products are certified organic and added to Organic Product List and the Organic System Plan

Please mail PAYMENT and FEE SCHEDULE (pages 23-24)

to :NMDA Marketing & Development

Attn: Elaine M PadillaMSC 5600, PO Box 30005

Las Cruces, NM 88003-8005

Please mail your APPLICATION (pages 1-22) to:

NMDA Organic Program 2604 Aztec Rd NE

Albuquerque NM 87107




Please complete the following pages to receive Cost-Share Reimbursement.



Application for Cost-Share Reimbursement 2016

Name of Certified Organic Business: _________________________________________________

Your Name:_____________________________________________________________________

Type of Certification (crop, livestock, processor):_______________________________________

Address: _________________________________________________________

City: ______________________ State: ______ Zip: ___________________

Phone: __________________________ Fax: ____________________________

Email: __________________________________________________________

Name of your certifier (NMDA, etc.): ______________________________________________

Allowed reimbursement costs for certification include: application fees, inspection fees, user fees, postage and assessments. Late fees and charges relating to violations of the organic standards are not eligible expenses. If you have questions about a particular expense, please call (575) 646-2752. If you are certified by NMDA you do not need to attach receipts unless you are claiming postage. If you are claiming postage or are not certified by NMDA you must attach receipts. Everyone must attach an itemized list of items to be reimbursed.

A) During the year10/1/15-9/30/16 I spent (the following amount) $ _____________ on organic certification expenses.

B) Multiply the amount above x .75. $______________

C) If the number on line B is larger than $750 you are eligible for a reimbursement of $750. If the number on line B is less than $750, that amount will be the amount of your reimbursement.

D) If you were first certified in 2016, or are certified by a body other than NMDA, please attach a copy of your certificate. This is REQUIRED!

TOTAL REIMBURSMENT:

I, ______________________________ understand that under the NOP cost-share program I am eligible to apply for 75% of my annual certification costs up to $750/year for Federal FY 2016, and nothing more. Awards of funds will be made on a first-come first-served basis (of the complete application); funds may not be available to reimburse every certified business.

____________________________________ Date: __________________

(sign here)

Please follow the instructions on the next page.

Please follow these instructions.

1. The Organic Cost-Share Program is a federal program, funded by the 2014 Farm Bill, to reimburse producers and processors for 75% of the cost of organic certification, up to $750. You must apply to receive reimbursement. If you have more than one certification (e.g. crop and processor) you may apply for EACH current certificate, but you must complete a separate application for each certified operation.

2. In New Mexico, the New Mexico Department of Agriculture is the agency responsible for distributing the federal funds. All certified organic New Mexico businesses are eligible for reimbursement as long as they have successfully completed the certification process and have a current certificate from a USDA-accredited certifier.

3. You must fill out the forms completely and include the required attachments to be reimbursed.

4. Requests for reimbursement must be received no later than 10/31/16.

5. There is no guarantee that funds will be available. Reimbursements will be issued on a first-come-first served basis until the money runs out.

6. What is important in figuring your certification costs for a particular year is the date that you wrote the check to cover those costs. Checks you wrote from 10/1/15-9/30/16 would be eligible for cost share reimbursement this year. Your “certification year,” (the date on your certificate or renewal) is irrelevant to this program. Eligible expenses generally are ones for which you paid your certifier. Application fees and assessments are eligible. Late fees charged for late application submission are not eligible.

7. Please don’t hesitate to call Elaine Padilla at (575) 646-2752 if you have any questions about this program. We want you to get your reimbursement.

What you have to doGuided by the information above:

1) Fill out the cost-share application and sign it.

2) Fill out the NMSU Vendor Questionnaire form. If you file taxes as a corporation or partnership you do NOT have to fill out the “Independent Contractor Determination” section on page 3 of the form. If you file as an individual, sole proprietor or LLC, you MUST complete the “Independent Contractor Determination” section of the form. In this section, check “no” on all the boxes. Under Question 8, please write the following: “I am not providing a service to NMSU but am being reimbursed for fees paid to NMDA.” Sign the form on page 4 where it says “Contractor’s Signature.”

3) Include a copy of your current organic certificate if you were first certified in 2016, or are not certified by NMDA.

4) Include an itemized statement of certification expenses; and, if not certified by NMDA or you are claiming postage, please attach receipts.

5) Please complete the Vendor Questionnaire. Click on the picture of a box below this section to access the document.

6) Do NOT send the vendor questionnaire (or anything else) to NMSU. Send ALL the above items to: NMDA Marketing & Development, Elaine M. Padilla MSC 5600, PO BOX 30005 Las Cruces, NM 88003-8005.

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