Form Ttb F 5150 19 – Fill Out and Use This PDF

1.NAME OF ARTICLE (PRODUCT) OR PROCESS IN WHICH SDA WILL BE USED

2.CODE NUMBER

3.FORMULA IS

NEW

PREVIOUSLY APPROVED

4.IF PREVIOUSLY APPROVED

5.NAME AND ADDRESS OF MANUFACTURER (Include Number, Street, City, State and ZIP Code) (State former name, if successor)

MAILING ADDRESS (If different from manufacturing address).

6.INDUSTRIAL USE PERMIT NO.

7.PURPOSE FOR WHICH THIS PRODUCT IS TO BE USED

8.IS THE PRODUCT TO BE PACKAGED IN PRESSURIZED CONTAINERS? (Specify propellant and ratio)

9. SIZES OF COMMERCIAL PACKAGES

10.SPECIALLY DENATURED ALCOHOL OR RUM FORMULA USED (Specify denaturants in formulas SDA-29, SDA-38B, SDA-38F)

11. PROOF OF SDA USED

YES

NO

14.SIGNATURE OF APPLICANT OR AUTHORIZED

AGENT

15. DATE

16.PERSON TO BE CONTACTED CONCERNING THIS SUBMISSION (Include Area Code, Telephone Number, and e-mail address)

LABORATORY NUMBER SAMPLE

ACTION

2.If TTB F 5150.19 covers the use of SDA Formula 39-C, also submit a 0.5 ounce sample of the essential oil used in the article. In addition, the Chief, Nonbeverage Products Laboratory, 6000 Ammendale Rd.,

Beltsville, MD., 20705-1250, may require the submission of samples of the finished article or any ingredient.

3.If TTB F 5150.19 covers the following activities, a statement of process is required:

a. The use of specially denatured spirits for laboratory or mechanical purposes, other than the use of SDA Formulas No. 3-A, 3-C, or 30 for laboratory or mechanical purposes not in the development of a product;

b. The use of specially denatured spirits in a manufacturing process in which none of the spirits remain in the finished product;

c. The use of specially denatured spirits, completely denatured spirits, or articles in a manufacturing process in which they are to be recovered; or

d. Where the recovered denatured spirits are to be redenatured.

4.If the specially denatured spirits are used as in paragraph 3.a. above, the Form 5150.19, Item 13, must identify the formula number of specially denatured spirits, a description of the laboratory or mechani- cal use, and the approximate annual quantity to be used.

5.If the specially denatured spirits are used as in paragraph 3.b., 3.c.,

ITEM 10. State the formula number of the specially denatured alcohol or rum to be used. Also state the choice of denaturants if using SDA-29, SDA-38B, or SDA-38F.

ITEM 11. State the proof of the spirits that will be used (190/200).

ITEM 12. State whether your manufacturing process includes recovery of spirits. If so, please refer to General Instructions 3 and 5.

ITEM 13. State the qualitative and quantitative formula for the article being manufactured. You may identify ingredients by generic names rather than brand names. You may identify quantities of ingre- dients used in ranges rather than finite quantities. The lower range for any ingredient may not be zero and the total range for any ingredient must not exceed ± 5 percent.

If an ingredient contains ethyl alcohol, you must state the percent alcohol by volume of that ingredient, if known, and the suppliers’ name and approval date of TTB F 5150.19.

LABELING

TTB regulations do not require that manufacturers of articles must file and obtain label approval. Manufacturers may voluntarily submit labels to the Alcohol and Tobacco Tax and Trade Bureau, Alcohol Labeling and Formulation Division, Washington, DC 20220, for a determination that the label complies with Subpart G, 27 CFR 20.134.

NOTICE

or 3.d. above, the Form 5150.19 must also contain the following information:

a. Flow diagrams clearly depicting the equipment in its relative operat- ing sequence, with essential connecting pipelines and valves. All

major equipment must be identified as to its use. The direction of flow through the pipelines must be accompanied by a written des- cription of the flow of materials through the system.

b. The statement of process must describe the chemical composition and quantity of the recovered spirits. The statement of process must be accompanied by a statement of the intended use of the recovered spirits.

SPECIFIC INSTRUCTIONS

ITEM 1. State the name of the article or product. If an article is not to be manufactured, state the use of the alcohol or rum.

ITEM 2. State the code number for the alcohol or rum used (e.g., 111). This designation is found in 27 CFR Part 21.

ITEM 3. State whether this submission is new or previously approved.

ITEM 4. If this formula has been previously approved, state the name of the manufacturer and the date of approval.

ITEM 5. State your company’s name and address of the manufacturing premises as shown on your Industrial Use Permit. If your most recent approved formula was obtained under a former name, please state the former name also. If the formula is to be mailed to an address different from the manufacturing premises, include this address also.

ITEM 6. State your Industrial Use Permit number; e.g., SDS-GA-100.

ITEM 7. State the name or use of the article being manufactured; e.g., hair lotion, insect repellent, ink solvent.

Approval by the Administrator of formulas, samples, or statements of process means only that they meet the standards of the Alcohol and Tobacco Tax and Trade Bureau. The approval does not require the Administrator to issue a permit under Subpart D of 27 CFR Part 20 to withdraw and use specially denatured spirits in those formulas, articles, or statements of process.

All formulas, samples, and statements of process submitted for examina- tion are considered to be trade secrets, and are therefore protected from public disclosure under the Freedom of Information Act, Public Law 93- 502, 88 Stat. 1563, 5 U.S.C. 552(b)(4).

PAPERWORK REDUCTION ACT NOTICE

This request is in accordance with the Paperwork Reduction Act of 1995. This information is used by TTB to determine that denatured spirits are used in an authorized manner and are safe for the consumer. The

information is required to obtain a benefit.

The estimated average burden associated with this collection is 54 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to

the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220.

An agency may not conduct or sponsor, and a person is not required to

respond to, a collection of information unless it displays a current, valid

OMB control number.