Form

Texas Department of Agriculture

Commissioner Sid Miller
Food Safety Modernization Act (FSMA) - Produce Safety Rule

Farm Inventory
Full Name *

First Name Last Name
Farm Name *
E-mail Address *
Website Address
Best Phone Number *

- Area Code Phone Number
Cell Phone Number

- Area Code Phone Number
Must provide the physical street address of the business; use EMS address for Rural Routes.

Farm Physical Address *

Mailing Address *

Food Safety Contact Information
Check one

This is the same person as listed above. We do not currently have a person listed in this position. My Farm has a Food Safety point person.
Full Name

First Name Last Name
Best Phone Number

- Area Code Phone Number
Cell Phone Number *

- Area Code Phone Number
E-mail Address
Farm Inventory Information
Number of water sources used:
Protected well
Surface water
City/Rural water districts
Does your farming operation use soil amendments of animal origin? (ex. Manure)

Yes No
Does your Farm (check all that apply)

grow produce harvest produce pack produce hold produce
Annual Sales (in the past 3 years) - check one

Exempt (Less than $25K) Very Small ($25K - $250K) Small ($250K - $500K) Large (Over $500K)
Is your produce for personal/on-farm consumption

Yes No
List Crops that you produce. You may select multiple items
Should be Empty:

Food Safety Modernization Act (FSMA) - Produce Safety Rule