In an effort to regulate and ensure the safe handling of bulk pesticides within the state, the Arkansas State Plant Board has outlined specific procedures and requirements through the DP-42 form. This comprehensive document serves as a formal application for manufacturers and dealers seeking permission to deliver and dispense bulk pesticides at designated dealer facilities. The form requires detailed information, including the EPA establishment number, as well as complete contact information for both the manufacturer and the dealer involved in the transaction. It mandates adherence to stringent conditions, such as product registration with the State Plant Board, clear labeling of containers with warning messages, and the enforcement of safety measures to preclude contamination and protect individuals, livestock, and crops. Additional requirements include the stipulation that handling practices comply with EPA and Department of Transportation regulations, the cleaning and relabeling of containers before reuse, and the necessity for metering devices to gain approval from the Weights and Measures Division. The DP-42 form not only facilitates regulatory oversight but also sets forth the responsibilities of the manufacturer and dealer, laying the groundwork for a controlled and secure distribution of bulk pesticides in Arkansas.
| Question | Answer |
|---|---|
| Form Name | Arkansas Form Dp 42 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | arkansas state plant board, arkansas state plant board pesticide license, arkansas plant board, arkansas state plant board pesticide division |
Form |
ARKANSAS STATE PLANT BOARD |
(Rev 09/08) |
DIVISION OF PESTICIDES |
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P. O. BOX 1069, LITTLE ROCK, ARKANSAS 72203 |
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APPLICATION FOR PERMISSION TO DELIVER BULK PESTICIDES |
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TO A DEALER’S FACILITY AND PERMISSION FOR THE DEALER |
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TO DISPENSE BULK PESTICIDES |
IN STR UC TIO N S: |
Complete and submit to the Arkansas State Plant Board. A signed copy will be returned upon approval to each |
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location. |
EPA ESTABLISHMENT NUMBER. _______________________________
________________________________________________________________________________________
Dealer’s Name
____________________________________________________________(______)_____________________
Complete Mailing AddressTelephone Number
________________________________________________________________________________________
CityStateZip Code
________________________________________________________________________________________
Manufacturer’s or Registrant’s Name
_____________________________________________________________(______)____________________
Complete Mailing AddressTelephone Number
________________________________________________________________________________________.
City |
State |
Zip Code |
The above manufacturer requests permission to deliver bulk pesticides and the above dealer request permission to install facilities for dispensing the pesticide to Arkansas licensed applicators at certain locations, as are hereinafter designated, subject to the following conditions:
1.All products will be registered with the State Plant Board by the manufacturer.
2.All containers to be dispensed from will be plainly marked by the dealer with paint or stenciling in large letters showing the name and address of the dealer applicant, and a phrase similar to “Warning
Contains Pesticides.”
3.All containers will bear a complete label, as registered, for the product therein, including the manufacturer’s name and address as provided by the manufacturer.
4.All containers must contain suitable sample points to permit sampling by personnel of the State Plant Board. Samples must be accepted without reservation as being representative of the material therein and described on the label attached.
5.All containers are charged or recharged, the filling inlet will be sealed by the dealer in such a manner as to prevent tampering with the contents.
6.The dealer must meet EPA established guidelines for handling bulk pesticides and in accordance with all Department of Transportation (DOT) regulations.
7.The dealer must make adequate provision for handling to prevent contamination or injury to persons, livestock, and crops.
8.The dealer and person in charge as indicated herein will be responsible for overall operation of the location.
9.In those cases in which the dealer is not the manufacturer’s agent, the manufacturer shall designate a resident agent for service of process.
10.Containers, prior to being used for a different pesticide, will be thoroughly cleaned by the dealer and relabeled.
11.All metering devices will be subject to approval of the Weights and Measures Division of the Plant Board.
BULK HANDLING LOCATION
Location (be specific)
________________________________________________________________________________________
________________________________________________________________________________________
Products (List complete brand name.)
Container 1 ______________________________________ Size _______ Gals. EPA Reg. No. ____________
Container 2 ______________________________________ Size _______ Gals. EPA Reg. No. ____________
Container 3 ______________________________________ Size _______ Gals. EPA Reg. No. ____________
Applicator (s)
__________________________________________________________________________________________
Manufacturer’s Resident Agent ________________________________________________________________
Address
__________________________________________________________________________________________
Dealer ____________________________________________________________________________________
Person in Charge ___________________________________________________________________________
Address ________________________________________________Phone No. ________________________
NOTE: If changes are desired after approval, an amendment to this application must be filed.
DO NOT WRITE IN THIS SPACE
APPROVED FOR 20 ______
_________________________________
PESTICIDE DIVISION
_______________________________
DATE
_______________________________
PERMIT NUMBER
Dealer______________________________________
Title _______________________________________
Date _______________________________________
Signature ___________________________________
Manufacturer ________________________________
Title _______________________________________
Date _______________________________________
Signature____________________________________