Form DP-63 "Hardship Permit Record Keeping Form" - Arkansas

What Is Form DP-63?

This is a legal form that was released by the Arkansas Agriculture Department - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2020;
  • The latest edition provided by the Arkansas Agriculture Department;
  • 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 DP-63 by clicking the link below or browse more documents and templates provided by the Arkansas Agriculture Department.

ADVERTISEMENT
ADVERTISEMENT

Download Form DP-63 "Hardship Permit Record Keeping Form" - Arkansas

Download PDF

Fill PDF online

Rate (4.4 / 5) 122 votes
Form DP-63 (Rev. 3/22)
HARDSHIP PERMIT
RECORD KEEPING FORM
(Use a separate form for each field)
Permittee Name (Please Print)
Permit #
County
Field Name
No. Acres
Field Location
Application Date
Applicator/Firm Name
Application:
Start
Circle
End
Circle
For Each
Time:
AM PM
Time:
AM PM
Load
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
Wind speed, wind direction, temperature and precipitation conditions should be recorded below at 10
minute intervals for duration of each load applied. Measurements must be made at the field of
application. Place an “X” to the left of the first reading for each load (as shown).
X
WS
WD
Temp
Precip.
(yes/no)
This completed form and a GPS map of the application to the field must be submitted to the Pesticide
Section of the Plant Industries Division within 10 days of the application.**SUBMIT RECORDS
TO
pesticide.hardshippermits@agriculture.arkansas.gov
**
Permittee Signature:
Form DP-63 (Rev. 3/22)
HARDSHIP PERMIT
RECORD KEEPING FORM
(Use a separate form for each field)
Permittee Name (Please Print)
Permit #
County
Field Name
No. Acres
Field Location
Application Date
Applicator/Firm Name
Application:
Start
Circle
End
Circle
For Each
Time:
AM PM
Time:
AM PM
Load
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
Wind speed, wind direction, temperature and precipitation conditions should be recorded below at 10
minute intervals for duration of each load applied. Measurements must be made at the field of
application. Place an “X” to the left of the first reading for each load (as shown).
X
WS
WD
Temp
Precip.
(yes/no)
This completed form and a GPS map of the application to the field must be submitted to the Pesticide
Section of the Plant Industries Division within 10 days of the application.**SUBMIT RECORDS
TO
pesticide.hardshippermits@agriculture.arkansas.gov
**
Permittee Signature: