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Self Certification

All stores in Santa Barbara that sell a line of groceries must complete this form.

If you experience difficulties, contact Lorraine Cruz-Carpenter, 564-5669, lcruz_carpenter@santabarbaraca.gov.

Bag Ordinance Self-Certification Form

I am one of the following stores:

Tier 1 Definition: "A store of at least 10,000 square feet of retail space that generates sales or use tax pursuant to the Bradley-Burns Uniform Local Sales and Use Tax Law (Part 1.5 (commencing with Section 7200) of Division of 2 of the Revenue and Taxation Code) which sells a line of dry grocery or canned goods, or non-food items together with some perishable food items or a store that has a pharmacy licensed pursuant to Chapter 9 (commencing with Section 4000) of Division 2 of the Business and Professions Code."

Tier 2 Definition: "A drug store, pharmacy, supermarket, grocery store, convenience food store, food mart, or other similar retail store or entity engaged in the retail sale of a limited line of grocery items or goods which typically includes, but is not limited to, milk, bread, soda, and snack foods, including those stores with a Type 20 or 21 liquor license issued by the State Department of Alcoholic Beverage Control."

Tier 1:

Supermarkets and stores with a pharmacy that have 10,000 square feet of retail space or more

Tier 2:

Smaller grocery, drug stores, pharmacies, convenience food stores, and food marts

Neither of the Above

All other stores are exempt from this ordinance.

* Your Name:

* Store Name:

* Store Street Address:

* Daytime Phone:

E-mail:

Self-Certify

I hereby understand that my store must be in compliance with the Single-Use Carryout Bag ordinance.

I declare under penalty of perjury of the laws of the State of California that the contents of this Self-Certification Report are true and correct.

* Initials (as signature)

Your Title:

* Verification

Please enter the word above in the space below

Last Updated: Aug 22, 2018