South Dakota Form A 94 A PDF Details

In South Dakota, individuals seeking to apply pesticides from the air must navigate through specific regulatory processes to ensure safety and compliance with state and federal guidelines. Central to this process is the South Dakota A 94 A form, a critical document for private aerial applicators. This form, issued by the Division of Agricultural Services, is an application that must be submitted alongside the Private Pesticide Applicator License Application. It requires detailed information about the applicant, including their name, contact details, and business or employer information. Furthermore, this form delves into the technical aspects of aerial application, asking for Federal Airman’s Certification numbers, Agricultural Aircraft Operator’s FAA Certificate details, and specifics about the aircraft to be used, such as make, model, year, and registration numbers. Applicants must also disclose their total flight hours, spraying and dusting experience, and, importantly, any prior approval successes or failures in pesticide application. To process this application, the South Dakota Aeronautics Commission mandates a thorough review of the applicant's background, experience, and flight operation details to ensure that aerial pesticide application is conducted safely and effectively within the state's jurisdiction. This form serves as a cornerstone document, ensuring that those who undertake such tasks are qualified, thereby safeguarding public health and environmental standards.

QuestionAnswer
Form NameSouth Dakota Form A 94 A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names2012 04pvtapplicappl _aerialv1 south dakota commercial aerial applicator form

Form Preview Example

Division of Agricultural Services

 

 

 

 

 

 

 

Foss Bldg, 523 E Capitol Ave

 

 

 

 

 

 

 

 

 

 

Pierre, SD 57501-3182

 

 

 

 

 

 

 

 

 

Phone: (605) 773-4432

Fax: (605) 773-3481

 

 

 

 

 

 

 

 

 

 

Web: sdda.sd.gov/Ag_Services

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form A 94 A

 

 

 

 

 

 

 

PRIVATE AERIAL APPLICATOR APPLICATION

 

 

 

 

 

 

 

 

(To be submitted with the P r i v a t e

Pesticide Applicator License Application)

Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

First

 

 

Middle Initial

 

 

 

 

Last

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

Street or Box

City

State

 

Zip+4

Phone No.

Business Name or Employer:

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street or Box

City

State

 

Zip+4

Phone No.

Email Address:

 

 

 

 

 

 

 

 

 

 

 

1.

Federal Airman’s Certification number:

 

 

 

 

Rating:

 

 

 

 

2.

Agricultural Aircraft Operator’s FAA Certificate

number & Date issued:

 

 

 

 

3.Will cover: (List each aircraft below)

Make

 

Model

 

Year

 

 

Federal ‘N’ No. (required)

 

 

South Dakota Reg. No.

 

 

 

 

 

 

 

 

 

(contact SD DOT to pay fee 605-773-4430)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.Has listed aircraft (including attached equipment) received FAA approval?

5.a. Total Pilot In Command (PIC) flight hours

b. Total (PIC) Hours: Single Engine-Tricycle Gear:

; Single engine-Conventional/Trail Dragger:

;

Helicopter:

 

; Other:

 

 

 

 

 

 

6.In reference to 5b, number of hours within the preceding 12 months by type.

7.

a. Total hours of spraying and/or dusting experience:

 

Within past year:

 

 

b. Equivalent hours of experience within the past year (e.g. Practice time).

 

______________

 

c. Have you successfully completed an FAA approved aerial applicator school? __________________________________

If so, please attach a copy if this is the first time application.

8.a. Number of acres in South Dakota, treated by the applicant within the past year. b. Number of flight hours involved in the treatment of the acreage in 8a.

9.Anyone who has less than 750 PIC Hours and has not previously sprayed under a Class B permit for 2 years or successfully completed an FAA approved aerial applicators school or have a current aerial applicators license from another state, must operate under the supervision of a SD licensed FAA Part 137 license holder.

Name of supervisor pilot

 

Signature

 

(Print)

10. Have you or any employer (for which you have ever worked) been denied permission to spray in any state? If yes, indicate employer, company, year of denial and state where denial was issued.

11.The information provided above is true and correct, to the best of my knowledge.

 

 

Signature

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OFFICE USE ONLY

 

 

 

APPROVED BY THE SOUTH DAKOTA AERONAUTICS COMMISSION

Date

 

 

Program

 

 

Class

 

 

 

 

 

Manager

 

 

 

 

Revised 04/2012