21 C.F.R. § 80.21
A request for certification of a batch of color additive shall:
A sample accompanying a request for certification must be submitted under separate cover and should be addressed to the Color Certification Branch.
Date ________
Office of Cosmetics and Colors (HFS-100),
Center for Food Safety and Applied Nutrition,
Food and Drug Administration,
5001 Campus Dr.,
College Park, MD 20740
In accordance with the regulations promulgated under the Federal Food, Drug, and Cosmetic Act, we hereby make application for the certification of a batch of straight color additive.
Name of color _______________________________
(As listed in 21 CFR part 74 )
Batch number _______________________________
(Manufacturer's number)
Batch weighs ____ pounds
Batch manufactured by ____________ at __________________ (Name and address of actual manufacturer)
How stored pending certification _______________________________
_______________________________
(State conditions of storage, with kind and size of containers, location, etc.)
Certification requested of this color for use in _______________________________
_______________________________
_______________________________
(State proposed uses)
Required fee, $____ (drawn to the order of Food and Drug Administration).
The accompanying sample was taken after the batch was mixed in accordance with 21 CFR 80.22 and is accurately representative thereof.
(Signed) ____________________
By ____________________
____________________
(Title)
Date ________
Office of Cosmetics and Colors (HFS-100),
Center for Food Safety and Applied Nutrition,
Food and Drug Administration,
5001 Campus Dr.,
College Park, MD 20740
In accordance with the regulations promulgated under the Federal Food, Drug, and Cosmetic Act, we hereby make application for the certification of a batch of color additive lake.
Name of color _______________________________
Batch number _______________________________
(Manufacturer's number)
Batch weighs ____ pounds
Name of color used _______________________________
Quantity ____ pounds
Lot number _______________________________
(When certification of the lake
for use in foods is requested)
Precipitant used _______________________________
Substratum used _______________________________
Quantity ____ pounds
Batch manufactured by __________ at ______________ (Name and address of actual manufacturer)
How stored pending certification _______________________________
_______________________________
(State conditions of storage, with kind and size of containers, location, etc.)
Certification requested of this color for use in _______________________________
_______________________________
_______________________________
(State proposed uses)
Required fee, $____ (drawn to the order of Food and Drug Administration).
The accompanying sample was taken after the batch was mixed in accordance with 21 CFR 80.22 and is accurately representative thereof.
(Signed) ____________________
By ____________________
____________________
(Title)
Date __________
Office of Cosmetics and Colors (HFS-100),
Center for Food Safety and Applied Nutrition,
Food and Drug Administration,
5001 Campus Dr.,
College Park, MD 20740
In accordance with the regulations promulgated under the Federal Food, Drug, and Cosmetic Act, we hereby make application for the certification of a batch of color additive repack.
Name of color _______________________________
(As listed in regulations and as certified; or repacker's name, if a mixture)
Original lot number _______________________________
Certified color content _______________________________
This color obtained from _______________________________
Batch number _______________________________
Batch weighs ____ pounds
How stored pending certification _______________________________
_______________________________
(State conditions of storage, with kind and size of containers, location, etc.)
Certification requested for use in _______________________________
_______________________________
_______________________________
(State proposed uses)
Required fee, $____ (drawn to the order of Food and Drug Administration).
The accompanying sample was taken after the batch was mixed in accordance with 21 CFR 80.22 and is accurately representative thereof.
(Signed) __________________
By ____________________
____________________
(Title)
Date __________
Office of Cosmetics and Colors (HFS-100),
Center for Food Safety and Applied Nutrition,
Food and Drug Administration,
5001 Campus Dr.,
College Park, MD 20740
In accordance with the regulations promulgated under the Federal Food, Drug, and Cosmetic Act, we hereby make application for the certification of a batch of color additive mixture.
Name of mixture _______________________________
(Manufacturer's trade name)
Batch number _______________________________
(Manufacturer's number)
Weight of batch ____ pounds
Volume of batch ____ (If liquid) gallons
Batch manufactured by _______________________________
Constituents of the mixture:
Name of color as certified Lot number
_______________________________
_______________________________
Quantity used (in pounds) Obtained from
_______________________________
_______________________________
Name of diluent
_______________________________
_______________________________
Quantity used
By volume
By weight (if liquid)
_______________________________
_______________________________
Batch mixed as follows _______________________________
(Describe in detail)
How stored pending certification _______________________________
_______________________________
(State conditions of storage, with kind and size of containers, location, etc.)
Certification requested for use in _______________________________
_______________________________
_______________________________
(State proposed uses)
Required fee, $____ (drawn to the order of Food and Drug Administration).
The accompanying sample was taken after the batch was mixed in accordance with 21 CFR 80.22 and is accurately representative thereof.
(Signed) ____________________
By __________________
____________________
(Title)
21 C.F.R. §80.21