Form Dpr Enf 117 PDF Details

In California, the management and reporting of pesticide use around vulnerable populations, particularly in schools and child day care facilities, are regulated with meticulous care. This essence of responsibility is encapsulated in the DPR-ENF-117 form, a document that serves as a comprehensive report for pesticide application within these sensitive areas. Revised in August 2011, this two-page document acts as a bridge between businesses operating under the Department of Pesticide Regulation's Pest Management & Licensing Branch and the regulatory requirements set forth by the state. It meticulously records critical information about pesticide application, including the business or operator's name, address, and registration/license number, alongside the details of the pesticide used such as its manufacturer, name, EPA or California registration number, and the amount applied. Moreover, it categorizes the application by various pest control codes—from structural and landscape maintenance to public health and vertebrate pest control, ensuring a thorough scrutiny of the types of pesticide applications. Also furnished are unique identifiers for the location of the pesticide use, ensuring that each application's specifics are transparently reported. Compliance with this form not only adheres to legal mandates but also underscores the commitment to safeguarding the health and environment of children's communal spaces from potential pesticide hazards.

QuestionAnswer
Form NameForm Dpr Enf 117
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesprenf117 school site and child day care facility pesticide use reporting form

Form Preview Example

STATE OF CALIFORNIA DPR-ENF-117 (REV. 08/11) Page 1 of 2

SCHOOL SITE AND CHILD DAY CARE FACILITY

PESTICIDE USE REPORTING

DEPARTMENT OF PESTICIDE REGULATION PEST MANAGEMENT & LICENSING BRANCH

APPLICATION YEAR BUSINESS REGISTRATION/LICENSE/CERTIFICATE #

BUSINESS/OPERATOR NAME

BUSINESS ADDRESS

CITY

STATE

ZIP CODE

BUSINESS PHONE NUMBER

School CDS #/Child Day Care Facility #

County

Date & Time

Location

Manufacturer & Name of

EPA/California Registration Number from

 

Amount Used

Code

OR Name & Address AND Specify if

 

Application

(# or name from

Product Applied

Label (include alpha code, if possible)

(and check one unit

(from list

School or Child Day Care Facility

 

Completed

list on back)

 

 

 

of measure)

on back)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School

 

LB OZ OZ

PT QT

 

 

(vol.) (wt.)

 

 

Day Care

GA

ML KG

 

L

GR

 

 

School

 

 

 

 

 

 

LB

OZ

OZ PT QT

 

 

(vol.)

(wt.)

 

 

Day Care

GA

ML KG

L

GR

 

School

 

 

 

 

 

 

LB

OZ

OZ PT QT

 

 

(vol.)

(wt.)

 

 

Day Care

GA

ML KG

L

GR

School

 

 

 

 

 

 

LB

OZ

OZ PT QT

 

 

(vol.)

(wt.)

 

 

Day Care

GA

ML

KG

L

GR

 

School

 

 

 

 

 

 

LB

OZ

OZ PT QT

 

 

(vol.)

(wt.)

 

 

Day Care

GA

ML

KG

L

GR

 

REPORT PREPARED BY

DATE

 

 

 

 

Report must be submitted to the Department of Pesticide Regulation, P.O. Box 4015, Sacramento, CA 95812-4015

STATE OF CALIFORNIA

DPR-ENF-117 (REV. 08/11)

Page 2 of 2

TYPES OF PEST CONTROL CODES:

DEPARTMENT OF PESTICIDE REGULATION PEST MANAGEMENT & LICENSING BRANCH

Code

10

- Structural Pest Control

..includes pest control work performed within or on buildings or other structures

Code

30

- Landscape Maintenance Pest Control...

includes pest control work performed on landscape plantings around buildings

Code

40

- Right-of-Way Pest Control

includes pest control work along roadsides, power lines, median strips, etc.

Code

50

- Public Health Pest Control

includes pest control work performed by or under contract with State or local public health or vector agencies

Code

80

- Vertebrate Pest Control

includes pest control work performed by public agencies or work under the supervision of the State or county agricultural commissioner

Code

91

- Nonfood/Nonfeed Fumigation

includes pest control work performed on commodities such as mattresses, furniture, etc.

Code 100 - Regulatory Pest Control

........................includes pest control work performed by public employees or contractors in the control of regulated pests

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCATION CODES:

 

 

 

 

 

 

 

 

1

Administration Bldg

5

Cafeteria/Kitchen

9

Landscape (indoor)

12

Locker Room

16

Restroom

2

Athletic Field

6

Classroom

10

Landscape (outdoor)

13

Multipurpose Room

17

Vehicle

3

Auditorium

7

Gymnasium

11

Library

14

Playground

18

Multiple Locations

4

Bldg, Exterior

8

Hardscape (parking lot, sidewalk, etc.)

 

 

15

Pool

19

Other (Please indicate)

 

 

 

 

 

 

 

 

 

 

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