N.H. FISH & GAME DEPARTMENT Permit No. 12345964785 Region 3, 225 Main St. Durham, NH 03824-4723 (603) 868-1095 New Hampshire Lobster Tail Permit (Fis 609.03) To process raw, shell-on lobster tails (see back) Complete and Return to: New Hampshire Fish and Game, Region 3, 225 Main St., Durham, NH 03824-4732. Please Print in Ink. All applications must be complete or will be returned. The Executive Director may, however, request additional clarification on any permit application. Owner or Person Responsible for Business: Owner Name ________ ___________ 6786868686787686786867868686788 (Last Name) (Suffix) (First Name) (Middle Initial) (Maiden name if applicable) Date of Birth // / Height Weight _________________ Hair Eyes 7781 Street Address________________________________________________________________ _______________________________ _________ _______________ (No.) (Street) (City) (State) (Zip) Mailing Address_______________________________________________________________ _______________________________ _________ _______________ (If different from above) (City) (State) (Zip) Daytime Telephone 252456666666666666666666666666 Nighttime Telephone 252456666666666666666666666666 Business: Name of Business 78997896786786786788678676786hhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh Federal Tax ID# 8999 Date of Incorporation // / Business Address _______________________________ __________________ (No.) (Street) (City) (State) (Zip) Type of Business (Individual Owner, Corporation, etc.) 15 67 Business Telephone 67867fhfhfhfhfh Contact Person(s) (If different from above.) fghh1 (Last Name) (Suffix) (First Name) (Middle Initial) Please list last name, suffix, first name, middle initial of additional contact person(s) on back. Processing Business: Location within facility where tails will be processed (Please describe) dfgfghfhfghhhhhhhhhhhhhhhhhhhhhhh________ ___________________________________________________________________________________________________________________________________________ Signature (Licensee subject to the penalties for making unsworn false statements under RSA 641:3) Do not write in this box Authorized by Executive Director (signature): Date of Issue________________ Expires____________________ Time of Issue_______________ Revised 09/08/2010 Contact Person(s) (If different from owner) _______________________________________________________________ (Last Name) (Suffix) (First Name) (Middle Initial) _______________________________________________________________ (Last Name) (Suffix) (First Name) (Middle Initial) _______________________________________________________________ (Last Name) (Suffix) (First Name) (Middle Initial) Fis 610.02 Lobster Tail Processing. (a) For purposes of this section, “lobster tails” means uncooked, raw shell-on American lobster tails, whether frozen or unfrozen, that have been separated from the carapace. (b) A person, firm or corporation properly licensed pursuant to RSA 211:49-c and who possesses a lobster tail processing permit specified in Fis 609.03 shall process lobster tails as follows: (1) Lobster tails shall only be removed from the lobsters at the land-based facility and at the location within the facility as specified on the lobster tail processing permit and not on any vessel whether at sea or dockside; (2) Lobster tails shall only be removed from live, legal size lobsters that meet all the requirements of Fis 602.12 and RSA 211:27. No lobster greater than the maximum legal length as described in RSA 211:27, III shall be used for lobster tail processing; (3) Lobster tails separated from the lobster shall remain whole, intact and in the shell; (4) All processing, freezing, packaging and labeling shall take place at the land-based facility and at the location within the facility as specified on the lobster tail processing permit; and (5) All packages and frozen or unfrozen lobster parts shall be labeled with: a. Description of the product; b. The permit number; c. The address of the facility where processed; and d. The date they were processed. (c) Permittees shall keep detailed, accurate records of all inventory and disposition of lobster tails and parts including the names and applicable license numbers for recipients at the facility for a period of 2 years. (d) Permittees shall submit an annual report as specified in Fis 608.05. (e) Lobster tails possessed and processed under the lobster tail processing permit shall not be sold within the state and shall be for export outside the jurisdiction of the state only. (f) Permittees shall be in compliance with the public health requirements pursuant to RSA 143 and RSA 146 and federal rules for hazards analysis critical control point (HACCP) specified in 21 CFR 123 and 1240..