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2. Name of Business*
4. Business Address*

   Where is this business located? (Not the mailing address)

6. Contact Name*
7. Contact Email Address*
8. Contact Phone Number
10. Business Type

    1. Grocery store
    2. Convenience store
    3. Venue or event center
    4. Restaurant (including fast food or take-out)
    5. Cafeteria
    6. Wholesale vendor or food distributor
    7. Hospital or hotel with on-site food facilities
    8. Other
12. Size or Capacity

    Please provide the capacity or the square footage of your business. 

14. Capacity

    Please provide the number of beds for your business. 

16. Size

    Please provide the square footage of your business. 

18. What type of food does your business produce or sell?*

    1. Produce, fresh fruit, fresh vegetables
    2. Meat, dairy, or other grocery
    3. Baked goods
    4. Packaged or processed foods (shelf stable)
    5. Prepared food (sold refrigerated or frozen for storage)
    6. Prepared food (sold for immediate consumption)
    7. Other
20. Please provide a description of the food your business produces or sells.
22. Does your business produce excess edible food?*

    This is food that is safe for consumption but is unsold. 

    1. Yes
    2. No
24. What does your business do with excess edible food?*

    1. I donate it to a food recovery organization (like a food pantry or charity)
    2. I give it to my employees or clients
    3. I dispose of it
    4. I return it to the vendor or food distribution company
    5. I do not have excess food
26. Please provide a description on the excess edible food your business has and what you do with it.
28. Thank you for your participation.

    This information helps the City of Modesto to identify which businesses that produce food qualify under SB 1383. We will contact you with more information and to advise you of your requirements for compliance. 

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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field