Form DP-42 "Application for Permission to Deliver Bulk Pesticides to a Dealer's Facility and Permission for the Dealer to Dispense Bulk Pesticides" - Arkansas

What Is Form DP-42?

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 fillable version of Form DP-42 by clicking the link below or browse more documents and templates provided by the Arkansas Agriculture Department.

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Download Form DP-42 "Application for Permission to Deliver Bulk Pesticides to a Dealer's Facility and Permission for the Dealer to Dispense Bulk Pesticides" - Arkansas

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Arkansas Department of Agriculture
Form DP-42
Plant Industries Division, Pesticide Section
(Rev 09/20)
1 Natural Resources Dr, Little Rock, AR 72205
APPLICATION FOR PERMISSION TO DELIVER BULK PESTICIDES
TO A DEALER’S FACILITY AND PERMISSION FOR THE DEALER
TO DISPENSE BULK PESTICIDES
Instructions: Complete application form and submit to the Pesticide Section. A signed copy will be returned upon approval.
EPA ESTABLISHMENT NUMBER:
Bulk Dealer’s Name:________________________________________________________________
Complete Mailing Address:
___________________________________________________________________________
City
State
Zip Code
Email Address:
Contact Person:
Telephone Number:
Physical Location Address:_____________________________________________________________
____________________________________________________________________________________
City
State
Zip Code
Pesticide Manufacture
:
**Please submit a separate application form for each manufacturer of bulk pesticides.**
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.
Container 4:
Size
Gals. EPA Reg No.
Container 5:
Size
Gals. EPA Reg No.
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 Pesticide Section of the Arkansas Department of
Agriculture by the manufacturer.
2.
Bulk License required for 500 gallon or larger containers.
Arkansas Department of Agriculture
Form DP-42
Plant Industries Division, Pesticide Section
(Rev 09/20)
1 Natural Resources Dr, Little Rock, AR 72205
APPLICATION FOR PERMISSION TO DELIVER BULK PESTICIDES
TO A DEALER’S FACILITY AND PERMISSION FOR THE DEALER
TO DISPENSE BULK PESTICIDES
Instructions: Complete application form and submit to the Pesticide Section. A signed copy will be returned upon approval.
EPA ESTABLISHMENT NUMBER:
Bulk Dealer’s Name:________________________________________________________________
Complete Mailing Address:
___________________________________________________________________________
City
State
Zip Code
Email Address:
Contact Person:
Telephone Number:
Physical Location Address:_____________________________________________________________
____________________________________________________________________________________
City
State
Zip Code
Pesticide Manufacture
:
**Please submit a separate application form for each manufacturer of bulk pesticides.**
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.
Container 4:
Size
Gals. EPA Reg No.
Container 5:
Size
Gals. EPA Reg No.
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 Pesticide Section of the Arkansas Department of
Agriculture by the manufacturer.
2.
Bulk License required for 500 gallon or larger containers.
Form DP-42 page 2
3.
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.”
4.
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.
5.
All containers must contain suitable sample points to permit sampling by personnel of the Arkansas
Department of Agriculture. Samples must be accepted without reservation as being representative of the
material therein and described on the label attached.
6.
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.
7.
The dealer must meet EPA established guidelines for handling bulk pesticides and in accordance with all
Department of Transportation (DOT) regulations.
8.
The dealer must make adequate provision for handling to prevent contamination or injury to persons,
livestock, and crops.
9.
The dealer and person in charge as indicated herein will be responsible for overall operation of the
location.
10.
Containers, prior to being used for a different pesticide, will be thoroughly cleaned by the dealer and
relabeled.
**If you have any questions, please call 501-225-1598 or email
pesticide.dealer@arkansas.gov
**
Name: _____________________________ Signature: ____________________________________
Title: ______________________________ Date: ____________________________________
DO NOT WRITE IN THIS SPACE
APPROVED FOR 20______
_____________________________
LICENSE NUMBER
__________________________________
ISSUE DATE
_____________________________________
PESTICIDE SECTION
Submit
Submit by email to
pesticide.dealer@arkansas.gov
Or mail to: Pesticide Section, 1 Natural Resources Dr, Little Rock, AR 72205
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