(Date) ________________
Name of State agency ____________
Post office address ____________
Street address ____________
City, State, and ZIP code ____________
Name of product(s) covered by the notification ____________
Reporting official, title, and telephone no. ____________
FAX No. ____________
Agency contact (if different from reporting official), title, and telephone no. ____________
Director,
Division of Enforcement (HFS-605),
Center for Food Safety and Applied Nutrition,
Food and Drug Administration,
5001 Campus Dr.,
College Park, MD 20740.
To Whom It May Concern:
The undersigned, ______, submits this letter of notification pursuant to section 307(b)(1) of the Federal Food, Drug, and Cosmetic Act
(21 U.S.C. 337(b)(1) ) with respect to ________. (name of products covered by the notification and the enforcement action that is to be initiated)
Attached hereto, and constituting a part of this letter of notification are the following:
Yours very truly,
Reporting Agency
By ____________
(Indicate authority)
21 C.F.R. §100.2