Aqs 278 Form PDF Details

Water is an essential element for life on Earth. Our planet comprises 71% water and, without it, humans would perish. The water cycle is a continuous process that involves the exchange of water between the land, oceans, and the atmosphere. This week's blog post will focus on Aqs 278 Form- a form used to report annual water use in California. The form must be completed by all water purveyors (i.e., public agencies, private companies) and submitted to the State Water Resources Control Board no later than April 1st of each year. The data collected through this form helps to identify trends in statewide water use and informs future policy decisions.

We've collected some quick details about the aqs 278 form. You may want to go through it just before writing the form.

QuestionAnswer
Form NameAqs 278 Form
Form Length2 pages
Fillable?Yes
Fillable fields89
Avg. time to fill out18 min 22 sec
Other namesdog and cat import form aqs 279, form dog cat import, hawaii health certificate form dog, hawaii health certificate form

Form Preview Example

ANIMAL QUARANTINE STATION 99-951 Halawa Valley Street, Aiea, Hawaii 96701 (808) 483-7151 RabiesFree@hawaii.gov

AQS 278 (11/11)

PAGE 1 of 2

DOG & CAT IMPORT FORM

I.FORM & DOCUMENTS Number of dogs and cats entering Hawaii:______ (Separate form must be filled out for each pet)

Except for the original health certificate, all documents must be received by the Animal Quarantine Station along with this completed form no less than 10 days before arrival to qualify for the 5-day-or-less and direct airport release program.

ESTIMATED DATE OF ARRIVAL

PET NAME

MICROCHIP NUMBER

SPECIES: DOG CAT

CHECK ALL DOCUMENTS ENCLOSED, INDICATE PROGRAM APPLYING FOR AND AMOUNT OF ENCLOSED PAYMENT

 

DOCUMENTS SUBMITTING

 

TYPE OF PROGRAM APPLYING FOR

 

RECENT

PREVIOUS

 

 

DIRECT

 

SUBSEQUENT

5 DAYS

NEIGHBOR ISLAND

 

RABIES

RABIES

* HEALTH

** HAWAII

AIRPORT

 

120 DAY

 

ENTRY $78 SEE

OR LESS

INSPECTION PERMIT

VACCINE

VACCINE

CERT.

HEALTH CERT.

RELEASE

 

$1,080

 

REQUIREMENT!

$224

$145

CERT.

CERT.

 

 

$165

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PREPAYMENT

AMOUNT ENCLOSED

Make money order or cashier's check out to: Department of Agriculture

NO PERSONAL CHECKS ACCEPTED

SEND ALL DOCUMENTS IN TOGETHER AS A SET WITH THIS DOG AND CAT IMPORT FORM COMPLETED AND NOTARIZED

* An original health certificate may be submitted upon arrival in Honolulu to State inspectors if not submitted w/ this form.

* *Owners of dogs and cats located in Hawaii that will be departing and returning for the 5-day-or-less program must also submit the original health certificate issued in Hawaii used for departure that contains the pet's Hawaii address and date of departure from Hawaii to qualify under the resident Hawaii pet requirements.

PET LOCATED IN HAWAII: Check box If pet will be leaving Hawaii and returning (Refer to Pets located in Hawaii requirements)

SUBSEQUENT ENTRY: Check box If pet is entering Hawaii again and give date of previous entry: (Refer to Re-Entry pet requirements to see if pet qualifies. Pet must meet qualifications for this lower fee )

II.PRIMARY OWNER INFORMATION - LEGAL OWNER OF PET REQUIRED (AUTHORIZED HANDLER INFORMATION USE SECTION IV!)

NAME: LAST

FIRST

M.I.

 

 

IDENTIFICATION NO. ( DRIVER'S LICENSE, STATE ID, MILITARY ID, S.S.) I.D. EXPIRATION DATE

BIRTH DATE

 

 

 

CURRENT ADDRESS: STREET

 

 

 

 

 

CITY

STATE

ZIP

 

 

 

TELEPHONE: HOME

WORK

CELL

 

 

 

E-MAIL ADDRESS:

 

 

 

 

 

 

 

 

HAWAII STREET ADDRESS: (if known)

 

 

 

 

 

CITY

ISLAND

ZIP

 

 

 

TELEPHONE: HOME

WORK

OTHER

 

 

 

III. OWNER GROUP Civilian Army

Navy Marines

Coast Guard

Air Force

IV. CO-OWNER or AUTHORIZED HANDLER / AGENT INFORMATION

PERSON IS: CO-OWNER HANDLER

 

(Co-owners are ALSO recognized as legal owners)

 

 

 

 

 

 

 

1

NAME: LAST

FIRST

 

M.I.

 

 

 

 

IDENTIFICATION NO. (DRIVER'S LICENSE, STATE ID, MILITARY ID, S.S. ,etc) I.D. EXPIRATION DATE

BIRTH DATE

 

 

 

 

 

 

TELEPHONE: HOME

WORK

 

OTHER

 

 

 

 

 

ANIMAL QUARANTINE STATION 99-951 Halawa Valley Street, Aiea, Hawaii 96701 (808) 483-7151 RabiesFree@hawaii.gov

AQS-278

 

PAGE 2 of 2

IV. CO-OWNER or AUTHORIZED HANDLER / AGENT (Continued) PERSON IS: □ CO-OWNER □ HANDLER

2

NAME: LAST

FIRST

 

M.I.

 

 

 

 

 

IDENTIFICATION NO. (DRIVER'S LICENSE, STATE ID, MILITARY ID, S.S. #,ETC)

ID EXPIRATION DATE

BIRTH DATE

 

 

 

 

 

 

TELEPHONE: HOME

WORK

CELL

 

 

 

 

 

 

V.AUTHORIZED VISITORS: (INDIVIDUALS YOU AUTHORIZE TO VISIT YOUR PET IN QUARANTINE BUT DO NOT HAVE AUTHORITY TO ACT ON YOUR BEHALF. MUST BE 18 YEARS OF AGE OR OLDER TO VISIT ALONE W/O OWNER OR AUTHORIZED ADULT.

1

2

3

NAME: LAST

FIRST

M.I.

I.D. NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

VI. PET INFORMATION

PET NAME

SPECIES DOG

MICROCHIP NUMBER

BREED CODE

 

 

CAT

 

 

 

 

 

 

 

COLOR CODE(S)

NEUTERED/SPAYED?

SEX

 

 

YES

NO

MALE

FEMALE

 

 

 

 

AGE

MARKINGS or DISTINGUISHING CHARACTERISTICS

 

 

MEDICATIONS or SPECIAL DIET (OWNER MUST PROVIDE)

VII. APPROVED ANIMAL HOSPITAL (NOT REQUIRED FOR DIRECT AIRPORT RELEASE)

Refer to the list of approved animal hospitals and indicate which hospital you wish your pet to attend IN CASE OF EMERGENCY when it is determined that your pet requires hospitalization. Owner(s) must register the pet with the selected hospital and provide the Animal Quarantine Station with proof of registration. Hospitals will not accept or treat unregistered pets.

Code: _____ _____ _____ _____

Name of Hospital: __________________________________________

VIII. AGREEMENT

I intend to enter the above-described animal into the State of Hawaii in compliance with the provisions of Hawaii Administrative Rules (“HAR”) Chapter 4-29. I hereby agree to pay to the Department of Agriculture, in full at the time the animal enters Hawaii, or enters quarantine in Hawaii, whichever happens first, the total amount of fees prescribed by those Rules for the required program. A summary of the fees is as follows: $165 for direct airport release; $224 for 5-day-or-less quarantine; $145 for Neighbor Island Inspection Permit; or $1,080 for 120-day quarantine. The prescribed fee for animals transiting to other destinations is $30 registration fee; $15 health record fee; plus $14.30 per day. In addition, a fee will be assessed for animals that remain in quarantine beyond the scheduled release date, at the rate of $17.80 per day. Arrival before the eligible date will result in charges of $14.30 per day plus additional program fees. Any refund of fees will be in accordance with HAR § 4-29-17. Allow six to eight weeks after the animal’s release from quarantine for any refunds.

I further agree to pay, prior to release of the animal, for any additional owner-approved services, and for any services deemed necessary by the station veterinarian to ensure the health and safety of the animal. I will immediately notify the animal quarantine station in writing of any changes in address or contact information during the time the animal is in the custody of the HDOA; and I acknowledge that any animal remaining in quarantine ninety (90) days or more after the scheduled release date, for any reason, shall be deemed abandoned and may be disposed of at the discretion of the animal quarantine manager, including placement by adoption or euthanasia, without further notice and without liability on the part of the State or the Department of Agriculture. I acknowledge that the fees and requirements above are a summary of the exact requirements that are established by HAR Chapter 4-29, and that those rules and applicable law govern all aspects of the animal quarantine program. Additional summary information and references are posted at hawaii.gov/hdoa/ai/aqs/info.

I hereby authorize and certify the above to be true.

Signature of Primary Owner

Date

Notary Public or Authorized HDOA Employee

Date

How to Edit Aqs 278 Form Online for Free

The PDF editor was built to be as straightforward as possible. Since you comply with these actions, the process of preparing the hawaii health certificate form file will undoubtedly be stress-free.

Step 1: The first step should be to select the orange "Get Form Now" button.

Step 2: At this point, you're on the form editing page. You may add content, edit existing details, highlight particular words or phrases, put crosses or checks, insert images, sign the template, erase unrequired fields, etc.

Make sure you type in the next details to create the hawaii health certificate form PDF:

portion of fields in hawaii quarantine forms

Type in the data in the NAME, LAST FIRST, ID, EXPIRATION, DATE BIRTHDATE, CURRENT, ADDRESS, STREET CITY, TELEPHONE, HOME EMAIL, ADDRESS STATE, WORK, HAWAII, STREET, ADDRESS, if, known CITY, ISLAND, TELEPHONE, HOME and WORK field.

hawaii quarantine forms NAMELAST, FIRST, IDEXPIRATIONDATE, BIRTHDATE, CURRENTADDRESSSTREET, CITY, TELEPHONEHOME, EMAILADDRESS, STATE, WORK, HAWAIISTREETADDRESSifknown, CITY, ISLAND, TELEPHONEHOME, and WORK blanks to complete

The application will request you to present particular vital info to instantly fill out the part ID, EXPIRATION, DATE BIRTHDATE, TELEPHONE, HOME WORK, and OTHER.

stage 3 to finishing hawaii quarantine forms

It is essential to identify the rights and responsibilities of all parties in space A, QS, PAGE, of NAME, LAST FIRST, ID, EXPIRATION, DATE BIRTHDATE, TELEPHONE, HOME WORK, CELL, NAME, LAST FIRST, ID, NUMBER VI, PET, INFORMATION PET, NAME COLOR, CODES and MICROCHIP, NUMBER

hawaii quarantine forms AQSPAGEof, NAMELAST, FIRST, IDEXPIRATIONDATE, BIRTHDATE, TELEPHONEHOME, WORK, CELL, NAMELAST, FIRST, IDNUMBER, VIPETINFORMATION, PETNAME, COLORCODES, and MICROCHIPNUMBER blanks to insert

Finalize by taking a look at the next areas and completing them as required: Code, Name, of, Hospital and VIII, AGREEMENT

Completing hawaii quarantine forms stage 5

Step 3: If you are done, hit the "Done" button to upload the PDF document.

Step 4: It can be easier to create duplicates of your document. There is no doubt that we are not going to share or view your information.

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