Application For Nc Good Agricultural Practices printable pdf download

Agricultural

Certification

Program

N. C. Good

Practices

Assistance

North Carolina

Agriculture

(NCDA&CS)

Dept. of

and Consumer Services

Application Form

This program is a cost share program designed to assist fruit and vegetable growers

with the cost of a GAP/GHP audit. The NCDA&CS will pay up to $600 of the cost of

having a third party audit to verify a farm's food safety program for first time users; $300

for those who have previously participated in the program. Funds will be paid to the

auditor conducting the GAP/GHP audit to reduce the cost to the farmer by up to

$600/$300. Participating farmers will be responsible for paying the auditor for any

balance due above $600/$300. Funds are available on a first come first served basis

until the funds are depleted. Applications must be submitted for approval to participate

in this program to the NCDA&CS prior to receiving the GAP/GHP audit. Payments are

limited to $600 per farm or company for audits conducted in 2012.

Date:______________________________

Name of applicant:_____________________________________________________

Farm Name:____________________________________________________________

Address:______________________________________________________________

City: _________________State:_______ZIP:____________County________________

Phone:___________________________Fax:_________________________________

E-mail:_______________________________________________________________

Name and address of certifying Agency or company that will perform your GAP/GHP audit:

Name:________________________________________________________________

Address:_______________________________________________________________

City:__________________________ State:________ Zip:_______________________

Telephone:_____________________________________________________________

My third party GAP/GHP audit will be conducted for the following areas:

Farm Review_________

Field Harvest and Field Packing_______

Packing House Facility__________

Storage and Transportation__________

Estimated Date third party GAP/GHP audit will be conducted:_____________________

Crop(s) to be included in the GAP/GHP audit:_________________________________

I am a North Carolina fruit and/or vegetable grower/packer. I plan to have my

farm,/packing house audited for GAP/GHP. I understand that the auditor that performs

my GAP/GHP audit will be paid up to $600 of the cost of the audit by NCDA&CS and I

am responsible for any balance due above $600.

Signature of Applicant:____________________________________________________

Mail or fax to: NCDA&CS - GAP Certification Assistance Program

Shirley Nicholson

1020 Mail Service Center

Raleigh, NC 27699-1020

FAX:919-715-0155

Application For Nc Good Agricultural Practices

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