STATE OF CALIFORNIA
Department of Food and Agriculture
Division of Measurement Standards (DMS)
California Type Evaluation Program (CTEP)
http://www.cdfa.ca.gov/dms/dms@cdfa.ca.gov
DMS Form 40-100 (Rev. 2/2023)

APPLICATION FOR EVALUATION OF A
WEIGHING OR MEASURING DEVICEAPPLICATION TYPE
CTEP Certificate ofNew:
Approval (COA) # to be
Amendment:
Amended:A) APPLICANT INFORMATION (Contact(s) during the evaluation)
Applicant Name:
Phone:
Co-Applicant Name:
Phone:
Co-Applicant Name:
Phone:

E-Mail
E-Mail
E-MailB) COMPANY INFORMATION (As marked on the device)
Company Name:
Address:
State:
Additional Country Info:
Phone:
Contact Person:
E-Mail:

CityCountry

Zip Code:

Fax:
Website:C) PROJECT BILLING AND ANNUAL ADMINISTRATIVE FEE CONTACT(S) (This section must be completed)
Company Name:
Address:
State:
Additional Country Info:
Contact Person:
E-Mail:Alt. Contact Person:
Alt. E-Mail:

City:
Country:

Zip Code:

Phone:
Alt. Phone:
FOR OFFICIAL USE ONLYCTEP PROJECT NUMBER (TA#):DATE APPLICATION RECEIVED:PROCESSED BY:
APPLICATION VERIFIED BY AND DATE:D) TYPES OF DEVICE(S) AND DESCRIPTION
Automotive Bulk Weighing System
Automatic Weighing Systems
Axle-Load Scales
Batch Controller
Belt-Conveyor Scales
Bench/Floor Weighing Elements
Card Readers
CNG Indicating Element
Computing Scale
Console Controller
Crane Scales
Cryogenic Meters
Electric Vehicle Supply Equipment
Electronic Cash Register - Measuring
Electronic Cash Register - Weighing
Floor Weighing Element
Hanging Scales
Hopper Scales
Hydrocarbon Gas Vapor Meters
Hydrogen Gas-Measuring Device
Jeweler's Scales
Liquefied and Compressed Gas Meters
Liquid Measuring Indicating Element
Load Cells
Loading Rack Meters
Mass Flow Meters
Measuring Device Software
Description of device not listed above:

Measuring Register / Indicator
Meter Indicating Mass
Meter Indicating Volume
Monorail Scale
Non-Computing Scale
On-Board Weighing Systems
Other Measuring Devices
Other Weighing Devices
Point-of-Sale (POS) Scales
POS Systems
POS Retail Motor Fuel Dispenser
Postal Scales
Prepackaged Scales
Prescription Scales
Printers
Railway Track Scales
Retail Motor Fuel Dispenser
Scale System Controller
Shipping Scales
Taximeters
Transportation Network Measurement Syst.
Vapor Recovery Nozzle
Vehicle Tank Meters
Vehicle Weighing Element
Water Meters
Watthour Meters
Weigh-in / Weigh-out System
Weighing/Load Receiving ElementE) INTENDED METER SIZE(S), ALL UNITS OF MEASURE, AND FLOW RATESF) INTENDED SCALE TYPE, MASS UNITS OF MEASURE, AND CAPACITYG) MODEL NUMBERS OR DESIGNATION (As it appears on the Hard ID or Software Screen ID)

H) DESCRIBE THE METHOD OF SEALINGI) INITIAL DEPOSIT REQUEST AND PAYMENT INFORMATIONFees:
Description:
Non-Refundable Application Fee
Initial Deposit Amount
Total Amount Due Today:

FEES$500.00$2,500.00$3,000.00

Make checks or money orders payable to: CDFA-505
Mail your payment to:
CDFA DIVISION OF MEASUREMENT STANDARDS
P.O. Box 942878
SACRAMENTO, CA 94271
Payment by Credit Card:
CTEP Program does accept credit cards for deposit payments and annual Administrative Fees;
however, you must contact the Division before attempting to use the link provided below.
CTEP Credit Card Payment link: https://secure.cdfa.ca.gov/egov/ctep/
Signature:
By endorsing this document, you agree to abide by all provisions of the California Businessand Professions Code, Div. 5 and the California Code of Regulations, Title 4, Div. 9.
Signature:
Printed Name:
Title:
Date Signed:
E-Mail:Phone:
Questions? Contact the CTEP Administrative Helpdesk by phone at (916) 229-3000 or byemail at dms@cdfa.ca.gov.