Form Vpa 013 PDF Details

In the realm of public health and environmental protection, the meticulous regulation of pesticide application is a paramount concern, particularly within the state of New Jersey. At the heart of these regulatory efforts is the VPA-013 form, a crucial document administered by the New Jersey Department of Environmental Protection through its Pesticide Control Program. This form, specifically designated for the initial licensing of pesticide applicator businesses, encapsulates a broad spectrum of information critical to ensuring that such entities operate within the state's rigorous safety, environmental, and public health standards. The VPA-013 mandates comprehensive details, spanning from basic business identifiers like name and contact information to more specialized data including the types of pesticide work the business intends to perform and proof of liability insurance. Key instructions underscore the importance of clarity and completeness in the submission, a testament to the form's role in safeguarding public health and environmental integrity. Additionally, the inclusion of county codes and a diverse list of pesticide work categories reflects the state's acknowledgment of the varied and nuanced nature of pesticide application across different locales and sectors. As a gatekeeper for entry into New Jersey's pesticide application industry, the form carries the weighty responsibility of filtering for competence, preparedness, and accountability, embodied in the requirement for a signature from a responsible certified pesticide applicator. With stipulations that underscore the serious consequences of providing false or misleading information, the VPA-013 form stands as a cornerstone in New Jersey's commitment to responsible pesticide management and the overarching goal of protecting its citizens and natural habitats from potential harm.

QuestionAnswer
Form NameForm Vpa 013
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesBergen, NJ, vpa 013 form, 2-FOREST

Form Preview Example

VPA-013

NJ Department of Environmental Protection

4/03

Pesticide Control Program - MC401-04A

PO Box 420, Trenton, NJ 08625-0420

Web page: www.pcpnj.org

APPLICATION FOR THE INITIAL LICENSING OF A

PESTICIDE APPLICATOR BUSINESS

OFFICE USE ONLY

License #

IMPORTANT INSTRUCTIONS: 1.

Type or print clearly

4.

Put a blank space between each word

2.

Use 1 space for each letter or number

5.

Complete ENTIRE form (including signature)

3.

Always start in leftmost space

6.

Incomplete forms will be rejected

 

 

BUSINESS NAME & PHONE #

 

 

BUSINESS NAME

 

 

 

 

 

AREA CODE

PHONE #

 

 

BUSINESS PHONE

#

 

 

 

 

MAILING ADDRESS OF BUSINESS

 

STREET OR BOX #

 

 

 

 

CITY

 

STATE

 

ZIP CODE

 

PHYSICAL ADDRESS OF BUSINESS

 

STREET

 

 

 

 

CITY

 

STATE

ZIP CODE

COUNTY

 

 

 

 

USE COUNTY CODE

 

 

 

 

ON OTHER SIDE

 

LIABILITY INSURANCE AGENT INFORMATION

BUSINESS NAME OF INSURANCE AGENT

 

 

 

 

 

AREA CODE

PHONE #

 

INSURANCE AGENT PHONE #

 

 

 

 

LICENSE # AND NAME OF RESPONSIBLE CERTIFIED PESTICIDE APPLICATOR

LICENSE #

FIRST NAME

MI

LAST NAME

 

 

TYPE OF PESTICIDE WORK DONE BY THIS BUSINESS

 

Place an 'X' in the box next to each category of work likely to be done by this business

1A-AGRICULTURAL PLANT

7A-GENERAL & HOUSEHOLD

8C-CAMPGROUND

1B-AGRICULTURAL ANIMAL

7B-TERMITES & OTHER WOOD

8D-COOLING WATER

 

 

DESTROYING INSECTS

 

2-FOREST

 

 

 

8E-SEWER LINE ROOT CONTROL

 

 

7C-FUMIGATION

 

 

3A-ORNAMENTALS

 

 

8F-PET GROOMING

 

 

7D-FOOD PROCESSING

 

3B-TURF

 

 

 

9-REGULATORY

 

 

7E-WOOD PRESERVING

 

3C-INTERIOR PLANTSCAPE

 

 

10-DEMONSTRATION & RESEARCH

 

 

7F-ANTIFOULANTS

 

4-SEED TREATMENT

 

 

11-AERIAL

 

 

8A-GENERAL PUBLIC HEALTH

 

5-AQUATIC

 

 

12A-WATER SANITIZATION

 

 

8B-MOSQUITO

 

 

6B-RIGHT-OF-WAY

 

 

12B-STERILIZATION

SIGNATURE REQUIRED

RESPONSIBLE CERTIFIED PESTICIDE APPLICATOR

NOTE: Providing false or misleading information on this form may result in denial, suspension or revocation of your licensing.

 

 

 

COUNTY CODES

 

 

01

- Atlantic County

08

- Gloucester County

15

- Ocean County

02

- Bergen County

09

- Hudson County

16

- Passaic County

03

- Burlington County

10

- Hunterdon County

17

- Salem County

04

- Camden County

11

- Mercer County

18

- Somerset County

05

- Cape May County

12

- Middlesex County

19

- Sussex County

06

- Cumberland County

13

- Monmouth County

20

- Union County

07

- Essex County

14

- Morris County

21

- Warren County

 

 

 

 

22

- Outside of NJ

 

 

 

 

 

 

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