AGRICULTURAL SERVICES CERTIFIED ORGANICMATERIALS VERIFICATION PROGRAM

Application for Materials Verification(A separate application must be submitted for each product)

Type of verification requested: NOP Compliance  CDFAPre-Compliance

California leafy Green Marketing Agreement - Compost 

Export verification to foreign country requirements / NOP Export Arrangements/Agreements:

Canada  EU Japan  Taiwan 

Check type ofproduct (√):  Fertilizer  Crop Production Aid  Pesticide  Processing Aid  Post Harvest Material  Soil Amendment  Spray Adjuvant  Other ______

Product Brand Name: ______Is this a renewal product application? Yes No(circle one)

General Applicant Information:

Company Name / Contact Name / Title
Mailing Address
City / State
Ca / Zip Code
Phone / Fax
Email address / Website Address

Manufacturer Information: Do you manufacture this product?  Yes  No If no, please list the manufacturer below.

Company Name / Contact Name
Mailing Address
City / Zip Code / State
Phone / E-Mail address / Website
Do you have the authority for the Full Disclosure of Ingredients?  Yes  No / Changes to prior formula?  Yes  No
[If yes, attach current formula and documentation]

Distributor Information:

Company Name / Contact Name
Mailing Address
City / Zip Code / State
Phone / E-Mail address / Website

Signature of Authorized representative: ______Phone Number: ______

The person signing the application must be authorized to represent the firm and is responsible for notifying ASCO of any changes or updates to the above listed product.

The following documentsare required to be attached to your application- review process will not be started without these documents:

Attach check foreach product label to be reviewed- $350.00 per label.(Fees are required with application)

Confidential statement of formula(required)

Description of manufacturing process and process flow charts(required)

Product label(required)

 Material Safety Data Sheet for final product(required)

 Ingredient information

 Manufacturing process for each ingredient (required)

 Material Safety Data Sheet for each ingredient(required if applicable)

 Product label for each ingredient(required)

 Invoice or proof of purchase for each purchased ingredient& other information as required by ASCO.(required)

Fees

Manufacturers wishing to have products reviewed for use in organic production and handling may enter into the ASCO Material Verification Program on an annual basis (products must be re-evaluated annually). A non-refundable fee of $350.00 per productlabeland hourly researchwill be charge(call for complete estimate)for; research, reports, site inspection(Which includes: general expenses of time, travel, air fare and accommodations when necessary) and expenses associated with product samples taken and lab analysis results. All charges incurred will be to evaluate if a product is allowed, restricted or prohibited in relation to NOP requirements. The need for an onsite inspection is to verify NOP compliance in order to use a material in an organic operation. Applicant will be advised if an onsite inspection is required in order to have products reviewed and listed with ASCO.

The ASCO Material Verification Program is not a recommendation of products, its sole purpose is to

evaluate materials used in organic operations. Once products are evaluated, they will be listed on the ASCO Material Lists and this information will be made available to organic operations. ASCO will provide the manufacturer with a Verification Certificate stating the evaluation finding at the time of product review.

An onsite visit to the manufacturing facility includes: Inspection of manufacturing facility, auditing of records, balancing of product in/out, research of ingredients back to origin and their manufacturing process and drawing of product samples for analysis. An estimate for the onsite inspection will be provided to any operation entering into the ASCO Materials Verification Program. Once an application has been received with the initial label review fees, an operation can decide at that time whether to continue with the onsite inspectionbeyond the label review process.

Annual update verification: Annual update product review, annual updated certificate and listing of product thereafter will be charged at a rate of $250.00 per product label. Additional onsite inspections by ASCO will be done as ASCO deems necessary to reaffirm that products remain in compliance of NOP requirements. Additional onsite inspections will be at the manufactures expense.

ASCO is not responsible for manufacturer changes in product compositions at any time which nullifies

the product being allowed, or requires the product to be restricted or prohibited as required by NOP regulations.

Attached application check with filled out forms and associated documents listed above to the following:

ASCO

P.O. Box 4871

Salinas, CA 93912

If you were referred to ASCO, please list here → Referred By:______

P.O. Box 4871 * Salinas, CA 93912 * Phone: 831-449-6365 * Fax: 831-975-4414 *

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Doc 096 Material Verification Program – Application Form (3/5/14)