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Date:08/27/2024 11:05:07
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Created Date Created by

2024-08-26 10:56:58.0 ece14217

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Registration Expiration Date Registration Renewed Date
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2024-12-31
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Last Updated Registration Status Reason

2024-08-27 Initial registration

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Registration Status
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VALID

Is this facility engaged in the manufacturing/processing, packing, or holding of food for human or animal consumption in the United States?
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¤Yes ¡No
Are you a fishing vessel engaged in processing (21 CFR 1.226(f))?
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¤Yes ¡No
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Section 1: Type of Registration
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Facility Location: Foreign Registration
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UPDATE OF REGISTRATION INFORMATION:
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Registration Number: 14134959086 Pin No EB8x2hJA
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Are you the new owner of a previously registered facility?
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¡Yes ¤No
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Previous Owner's Title:
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Previous Owner's Name:
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Previous Owner's Registration Number:
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Section 2: Facility Name/Address Information
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Facility Name Telephone Number

LEVANTIS GIDA LIMITED SIRKETI 090 722 403610

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Facility Name Suffix Fax Number

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Company

Facility Street Address, Line 1 E-Mail Address

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mahmudiye mah., gokdelen ve taksim otel godelen is merkezi no:10

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Facility Street Address, Line 2 Unique Facility Identifier (UFI)

ic kapi no 352, kuvai milliyw gad.

on

City
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Mersin
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State/Province/Territory
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None of the above

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Zip Code (Postal Code)

34096
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 FD

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TURKEY
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Section 3: Preferred Mailing Address Information
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Complete this section if different from Section 2 Facility Name/Address Information (OPTIONAL)
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Is the preferred mailing address the same as the facility address (Section 2)? Yes
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Name Telephone Number
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LEVANTIS GIDA LIMITED SIRKETI 090 722 403610
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Address, Line 1 Fax Number

mahmudiye mah., gokdelen ve taksim otel godelen is merkezi no:10

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Address, Line 2 E-Mail Address
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ic kapi no 352, kuvai milliyw gad.

City
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Mersin
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State/Province/Territory

None of the above

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Zip Code (Postal Code)

34096
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TURKEY

Section 4: Parent Company Name/Address Information

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(If applicable and if different from Sections 2 and 3). If information is the same as another section, check which section:

¤Same as Facility Address (Section 2)

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¡Same as Preferred Mailing Address (Section 3)
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¡None of the above
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Company Name Telephone Number

LEVANTIS GIDA LIMITED SIRKETI 090 722 403610

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Company Name Suffix Fax Number

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Company

Address, Line 1 E-Mail Address

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mahmudiye mah., gokdelen ve taksim otel godelen is merkezi no:10

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Address, Line 2

ic kapi no 352, kuvai milliyw gad.

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City
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Mersin
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None of the above

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Zip Code (Postal Code)

34096
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TURKEY
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Section 5: Facility Emergency Contact Information
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If information is the same as another section, check which section:

¤Same as Facility Address (Section 2)

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¡Same as U.S. Agent Information (Section 7)
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¡None of the above
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Individual's Title (Optional) Emergency Contact Phone

090 722 403610

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Individual's Name (Optional) E-Mail Address
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[email protected]

Individual's Middle Name (Optional) Job Title (Optional)

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Individual's Last Name (Optional)

Section 6: Trade Names

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(If this facility uses trade names other than that listed in Section 2 above, list them below (e.g., "Also doing business as," "Facility also known as"))
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Are there alternate trade names used by your facility in addition to the name provided in Section 2: Facility Name/Address Information?
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¡Yes
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¤No
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Section 7: United States Agent
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(To be completed by facilities located outside any state or territory of the United States, District of Columbia, or The Commonwealth of Puerto Rico)

U.S. Agent ID Emergency Contact Phone

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USID8603314 917 6026021
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First Name Fax Number
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Ihab
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Middle Name (Optional) E-Mail Address
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[email protected]
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Last Name

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Title (Optional)
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Address, Line 1

2900 Regan St
on

Address, Line 2
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City
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Dallas
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State/Province/Territory
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Texas
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Zip Code (Postal Code)

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75219
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 FD

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UNITED STATES
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Section 8: Seasonal Facility Dates of Operation (Optional)
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Give the approximate dates that your facility is open for business, if its operations are on a seasonal basis (Optional).
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Harvest 1
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Start Month End Month
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Harvest 2
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Start Month End Month

Section 9: General Product Categories - Human/Animal/Both

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þFood for Human Consumption ¨Food for Animal Consumption
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Section 9a: General Product Categories - Food for Human Consumption; and Type of Activity Conducted at the
Facility
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To be completed by Ambient Food Refrigerated Food Frozen Food Acidified Low- Interstat Contract Labeler / Manufact Packer / Salvage Farm Other

all food facilities. Storage Warehouse Storage Warehouse Storage Warehouse Food Acid e Sterilizer Relabele urer / Repacke Operator Mixed- Activity
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Please see / Holding Facility / Holding Facility / Holding Facility Process Food Conveya r Process r (Recondi Type Conduct
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instructions for (e.g., storage (e.g., storage (e.g., storage or Process nce or tioner) Facility ed
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further examples. IF facilities, including facilities, including facilities) or Caterer / (Please
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NONE OF THE storage tanks, grain storage tanks) Catering Specify)
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MANDATORY elevators) Point
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CATEGORIES

BELOW APPLY,
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SELECT BOX 37
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17.FRUIT AND FRUIT PRODUCTS[21 CFR 170.3 (n) (16), (27), (28), (35), (43)]

þ þ þ ¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨
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a.Fresh Cut Produce
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Section 10: Owner, Operator, or Agent-in-Charge Information

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Provide the following information, if different from all other sections on the form. If information is the same as another section of the form, check which
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section:
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If information is the same as Section 2, check the box:

¡Section 2 - Facility Address Information

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¡Section 3 - Preferred Mailing Address Information

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¡Section 4 - Parent Company Address Information

¤Section 7 - US Agent Address Information
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¡None of the above

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Name of Entity or Individual Who is the Owner, Operator, or Agent-in-Charge: ihab grais
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Address, Line 1 Telephone Number

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2900 Regan St 001 917 6026021

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Address, Line 2 Fax Number

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City E-Mail Address

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Dallas [email protected]
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State/Province/Territory

Texas
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Zip Code (Postal Code)
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75219
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Country/Area

UNITED STATES
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Section 11: Inspection Statement
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þFDA will be permitted to inspect the facility at the time and in the manner permitted by the Federal Food, Drug, and Cosmetic Act.
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Section 12: Certification Statement

The owner, operator, or agent-in-charge of the facility, or an individual authorized by the owner, operator, or agent-in-charge of the facility, must
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submit this form. By submitting this form to FDA, or by authorizing an individual to submit this form to FDA, the owner, operator, or agent-in-charge of the
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facility certifies that the above information is true and accurate. An individual (other than the owner, operator or agent-in-charge of the facility) who submits

the form to the FDA also certifies that the above information submitted is true and accurate and that he/she is authorized to submit the registration on the
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facility's behalf. An individual authorized by the owner, operator, or agent-in-charge must below identify by name the individual who authorized submission
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of the registration. Under 18 U.S.C 1001, anyone who makes a materially false, fictitious, or fraudulent statement to the U.S. Government is subject to
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criminal penalties.
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NAME OF PERSON SUBMITTING THIS REGISTRATION FORM: HASAN BALOULI
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CHECK ONE BOX
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¤A. INDIVIDUAL ASSOCIATED WITH THE INFORMATION IN SECTION 10 (STOP HERE, FORM IS COMPLETED)
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¡B. ANOTHER AUTHORIZED INDIVIDUAL
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Address Information for the Authorizing Individual:
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Individual's Name Telephone Number
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-N/A- -N/A-

Address, Line 1 Fax Number

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-N/A- -N/A-
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Address, Line 2 E-Mail Address

-N/A- -N/A-
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-N/A-

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Zip Code (Postal Code)

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Country/Area
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-N/A-
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