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Blank Arkansas Dp 42 Form

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Free Arkansas Dp 42 File

Form Properties

Fact Name Description
Purpose The DP-42 form is used to apply for permission to deliver bulk pesticides to a dealer's facility in Arkansas.
Governing Law This form is governed by regulations set forth by the Arkansas State Plant Board and the Environmental Protection Agency (EPA).
Submission Process Applicants must complete the form and submit it to the Arkansas State Plant Board for approval.
Dealer Responsibilities Dealers must ensure that all containers are properly labeled and meet safety and handling regulations.
Approval Notification A signed copy of the approved application will be returned to each location listed in the application.
Amendments If changes are needed after approval, an amendment to the application must be filed.

Key takeaways

When filling out and using the Arkansas DP-42 form, it is essential to keep the following key takeaways in mind:

  • Thorough Completion: Ensure that every section of the form is filled out completely. Missing information can lead to delays in processing your application.
  • Clear Identification: Clearly identify the dealer and manufacturer’s information, including names, addresses, and telephone numbers. This information is crucial for communication and approval.
  • Compliance with Regulations: Familiarize yourself with the regulations regarding bulk pesticide handling. The dealer must adhere to EPA and Department of Transportation guidelines.
  • Labeling Requirements: All containers must be properly labeled. This includes the dealer’s name and a warning about the contents, which is vital for safety and compliance.
  • Responsibility: The dealer and the person in charge are responsible for the operation at the location. This includes ensuring safety measures are in place to prevent contamination and injury.

By keeping these points in mind, you can navigate the process more effectively and ensure compliance with state regulations.

Detailed Steps for Using Arkansas Dp 42

After completing the Arkansas DP-42 form, it is important to submit it to the Arkansas State Plant Board for approval. Once approved, a signed copy will be returned to each location specified in the application. Follow the steps below to fill out the form accurately.

  1. Begin by entering the EPA Establishment Number in the designated space at the top of the form.
  2. Provide the Dealer’s Name along with the complete mailing address and telephone number.
  3. Fill in the City, State, and Zip Code for the dealer's address.
  4. Next, enter the Manufacturer’s or Registrant’s Name and their complete mailing address, including the telephone number.
  5. Again, fill in the City, State, and Zip Code for the manufacturer’s address.
  6. Indicate the Bulk Handling Location by providing specific details about where the pesticides will be delivered and dispensed.
  7. List the Products that will be handled, including the complete brand name, size in gallons, and the EPA Registration Number for each container.
  8. Identify the Applicator(s) that will be serviced by the dealer.
  9. Provide the name and address of the Manufacturer’s Resident Agent.
  10. Fill in the name of the Dealer and the Person in Charge of the operation, along with their addresses and phone numbers.
  11. Review the form for any errors or omissions before submitting it.

Common mistakes

Completing the Arkansas DP-42 form requires attention to detail. One common mistake is failing to provide the EPA establishment number. This number is essential for identifying the location where pesticides are manufactured. Without it, the application may be considered incomplete and could lead to delays.

Another frequent error involves the dealer's contact information. Applicants often neglect to include a complete mailing address or an accurate telephone number. Incomplete contact details can hinder communication between the Arkansas State Plant Board and the dealer, potentially affecting the approval process.

Many applicants overlook the requirement to list all products accurately. It is important to specify the complete brand name and include the EPA registration number for each pesticide. Omitting this information can lead to confusion and may result in the rejection of the application.

Inadequate labeling of containers is another mistake. The form requires that all containers be plainly marked with the dealer's name and a warning about pesticide contents. Failure to follow this instruction can pose safety risks and violate state regulations.

Applicants sometimes do not ensure that all containers have suitable sample points for testing. This oversight can prevent the State Plant Board from conducting necessary inspections, which may lead to compliance issues down the line.

Another area of concern is the responsibility for overall operation. The form requires that the dealer and the person in charge be clearly identified. Failing to provide this information can create ambiguity regarding accountability, which is crucial for regulatory compliance.

Lastly, some applicants forget to include an amendment process in their application. If changes are needed after submission, the dealer must file an amendment to the application. Neglecting to mention this can lead to complications if adjustments are required later.

Arkansas Dp 42 Sample

Form DP-42

ARKANSAS STATE PLANT BOARD

(Rev 09/08)

DIVISION OF PESTICIDES

 

P. O. BOX 1069, LITTLE ROCK, ARKANSAS 72203

 

APPLICATION FOR PERMISSION TO DELIVER BULK PESTICIDES

 

TO A DEALER’S FACILITY AND PERMISSION FOR THE DEALER

 

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

 

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.

DP-42 page 2

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 -- The location, product(s), the applicator(s) to be serviced by the dealer, manufacturer’s resident agent, and the person in charge of the dealer’s operation will be as follows:

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____________________________________