Form P-2 "Application for License of Pesticides and Non-chemical Pest Control Devices" - Hawaii

What Is Form P-2?

This is a legal form that was released by the Hawaii Department of Agriculture - a government authority operating within Hawaii. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on August 25, 2020;
  • The latest edition provided by the Hawaii Department of Agriculture;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form P-2 by clicking the link below or browse more documents and templates provided by the Hawaii Department of Agriculture.

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Download Form P-2 "Application for License of Pesticides and Non-chemical Pest Control Devices" - Hawaii

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CODE:
Pesticides Branch
1428 S. King Street
Honolulu, HI 96814-2512
FOR OFFICIAL USE ONLY
APPLICATION FOR LICENSE OF PESTICIDES AND NON-CHEMICAL PEST CONTROL DEVICES
1. Firm Name
2. Mailing Address
City
State
Zip Code
3. Name of Person Responsible for License
Title
Telephone Number
Fax Number
E-mail Address
4. Principal Hawaii Distributor
Address
Zip Code
5. Brand Name (Exactly as shown on label)
EPA Registration Number
EPA Establishment Number
Confidential Statement of Formula (EPA Form No. 8570-4)
□ Is attached
□ Being submitted by basic registrant
Non-Chemical Pest Control Device Supporting Data Package:
□ Is attached
□ Being submitted by manufacturer
Microbial Product Permit from Hawaii Department of Agriculture, Plant Quarantine: □ Is attached
□ Being submitted by manufacturer or dealer
Firm Name on Label (If differs from Item 1)
6. Type of Pesticide (Check each applicable item)
□ Non-Chemical Pest Control Device
□ Insecticide
□ Fungicide
□ Herbicide
□ Rodenticide
□ Nematicide
□ Algicide
□ Germicide
□ Other
7. Type of Formulation
□ Microbial
□ Dust
□ Wettable Powder
□ Pressurized Product
□ Granular
□ Emulsifiable Liquid
□ Bait
□ Other
8. Type of Containers and Sizes
9. Signature of Authorized Representative
Type or Print Name
Date
(For State Use Only)
License Period
CERTIFICATE OF LICENSE
When signed under authority of the Chairperson, Board of Agriculture, this certifies that the pesticide / device named
above is duly licensed, license fee paid therefore and its sale in Hawaii authorized for the license period referred to,
pursuant to provisions of the Hawaii Pesticide Law (Chapter 149A, Hawaii Revised Statutes) and the Administrative
Rules, Chapter 66, Pesticides, Title 4, Department of Agriculture.
Date Issued
Receipt No.
Administrator, Division of Plant Industry
SEE FORM P-2a FOR INFORMATION ON FEES, LABELING, AND PROCEDURES
Form P-2
Revised 8/25/2020
CODE:
Pesticides Branch
1428 S. King Street
Honolulu, HI 96814-2512
FOR OFFICIAL USE ONLY
APPLICATION FOR LICENSE OF PESTICIDES AND NON-CHEMICAL PEST CONTROL DEVICES
1. Firm Name
2. Mailing Address
City
State
Zip Code
3. Name of Person Responsible for License
Title
Telephone Number
Fax Number
E-mail Address
4. Principal Hawaii Distributor
Address
Zip Code
5. Brand Name (Exactly as shown on label)
EPA Registration Number
EPA Establishment Number
Confidential Statement of Formula (EPA Form No. 8570-4)
□ Is attached
□ Being submitted by basic registrant
Non-Chemical Pest Control Device Supporting Data Package:
□ Is attached
□ Being submitted by manufacturer
Microbial Product Permit from Hawaii Department of Agriculture, Plant Quarantine: □ Is attached
□ Being submitted by manufacturer or dealer
Firm Name on Label (If differs from Item 1)
6. Type of Pesticide (Check each applicable item)
□ Non-Chemical Pest Control Device
□ Insecticide
□ Fungicide
□ Herbicide
□ Rodenticide
□ Nematicide
□ Algicide
□ Germicide
□ Other
7. Type of Formulation
□ Microbial
□ Dust
□ Wettable Powder
□ Pressurized Product
□ Granular
□ Emulsifiable Liquid
□ Bait
□ Other
8. Type of Containers and Sizes
9. Signature of Authorized Representative
Type or Print Name
Date
(For State Use Only)
License Period
CERTIFICATE OF LICENSE
When signed under authority of the Chairperson, Board of Agriculture, this certifies that the pesticide / device named
above is duly licensed, license fee paid therefore and its sale in Hawaii authorized for the license period referred to,
pursuant to provisions of the Hawaii Pesticide Law (Chapter 149A, Hawaii Revised Statutes) and the Administrative
Rules, Chapter 66, Pesticides, Title 4, Department of Agriculture.
Date Issued
Receipt No.
Administrator, Division of Plant Industry
SEE FORM P-2a FOR INFORMATION ON FEES, LABELING, AND PROCEDURES
Form P-2
Revised 8/25/2020