Do you know what a Dp 21 is? Do you know how it can help your business? If not, keep reading. A Dp 21 is an important document for businesses to have in case of disaster. This document contains all the important information about your company and its employees. Having a Dp 21 can help you get back on your feet quickly after a disaster strikes. Learn more about this document and how to create one for your business in today's blog post.
Question | Answer |
---|---|
Form Name | Form Dp 21 |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | insecticidal, registrant, arkansas form dp 21, AEPA |
Form
ARKANSAS
APPLICATION FOR REGISTRATION OF PESTICIDES
This registration is for the calendar year ending December 31,
Refer to back of page for instructions.
Please do not write in shaded areas of form.
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APD |
EPA |
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Product |
Complete Brand and Name of Pesticide |
FEE |
Registration |
Category |
Class |
Number |
EXEMPT |
Number |
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I hereby certify that the above representations and attachments are true and correct.
DO NOT write in this space
Approved
Pesticide Division
Date
Total Fee Enclosed $
Company Name
Mailing Address
City and StateZip
Signed
Printed Name
Title
Date of Application
Telephone Number
Fax Number
Once completed, make copy and sign both forms to be submitted
Instructions for the Arkansas Application for Registration of Pesticides
1.Indicate calendar year ending December 31.
2.AClass@ and AProduct Number@ columns: Do Not Write In This Space!
3.AComplete Brand and Name of Pesticide@ column: Indicate complete Brand and name of pesticide.
Registrants desiring to discontinue a product registration should be aware that Arkansas requires a
Please indicate
4.AAPD Fee Exempt@ column: Please indicate AY@ if a product is exempt or AN@ if a product is not exempt
Arkansas requires a $50.00 Abandoned Pesticide Disposal (APD) Fee for some products. This disposal fee does not apply to 1) Sanitizers and Disinfectants, 2) Aerosol products which are not labeled for agricultural use, 3) Insect repellants which are labeled for use on the human body or clothing, 4) Silica gels and other
5.AEPA Registration Number@ column: Indicate complete EPA Registration Number
6.ACategory@ column: Do Not Write In This Space!
7.ATotal Fee enclosed@: Please indicate the total amount of fees.
$ |
250.00 Registration Fee per product |
$ |
50.00 APD Fee per product, if not exempt. |
8.ACompany Name, mailing address, City and State, Signature, Printed Name Title, Date of Application, Telephone
Number and Fax Number@: Please complete for each page accordingly. Make copies of the page before Signing, then Original signatures are needed on the original and copy submitted. Once approved, the copy will returned for your records.
Submit the completed
-Check payable to State Plant Board for the total amount of fees
-One copy of a complete product label (8 2 x 11, or folded to such size), in order to correspond to the products listed on the application, for each product.*
-PDF format of a complete product label. The electronic document name needs to include the complete product name and the EPA Registration Number, and the document needs to be readable when printed. Labels may be submitted on a CD or emailed to brandi.reynolds@aspb.ar.gov.
-Out of channels of trade letter if applicable.
*(Registrants are only required to submit labels if the product is new to Arkansas or the label has been changed since the product was last registered in Arkansas)