Form PR-REG-004 "Request for a Special Local Need Registration (Snl), Section 24(C)" - California

What Is Form PR-REG-004?

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

Form Details:

  • Released on May 1, 2002;
  • The latest edition provided by the California Department of Pesticide Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form PR-REG-004 by clicking the link below or browse more documents and templates provided by the California Department of Pesticide Regulation.

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Download Form PR-REG-004 "Request for a Special Local Need Registration (Snl), Section 24(C)" - California

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STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE
REGULATION
REQUEST FOR A SPECIAL LOCAL NEED
PESTICIDE REGISTRATION BRANCH
1001 I STREET
REGISTRATION (SLN), SECTION 24(c)
SACRAMENTO, CALIFORNIA 95812-4015
(916) 445-4400
PR-REG-004 (Est. 7/91)(Rev. 05/02)
FAX - (916) 324-5872
Type of SLN: [ ] First-Party or [ ] Third-Party
It is recognized that the issuance of a SLN does not constitute a recommendation by the California Department of
Pesticide Regulation or relieve the user of any responsibility. USE ADDITIONAL PAGES IF NECESSARY.
Give a complete description of the problem. Also, submit evidence such as field data, copies of published articles, or
written statements by qualified experts that the special local need exists.
List any other products that are registered in California for this use. Give reasons why these alternatives are not
available or are not effective in controlling the pest(s).
For what similar use is the product registered?
Will the crop be marketed fresh or processed?
What, if any, are the anticipated hazards to bees, fish, wildlife or any nontarget organisms?
What will be the total amount of acreage treated? (estimate)
Has a residue tolerance been established for the food or feed crop?
ADDITIONAL REQUIREMENTS NECESSARY FOR THE ISSUANCE OF A SLN
1. A copy of the U.S. EPA Federal SLN, EPA Form 8570-25, signed by the proposed registrant.
2. Efficacy and phytotoxicity data: If the use is on a food crop, residue data is also required.
3. A letter of authorization from the manufacturer.
Page 1 of 2
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE
REGULATION
REQUEST FOR A SPECIAL LOCAL NEED
PESTICIDE REGISTRATION BRANCH
1001 I STREET
REGISTRATION (SLN), SECTION 24(c)
SACRAMENTO, CALIFORNIA 95812-4015
(916) 445-4400
PR-REG-004 (Est. 7/91)(Rev. 05/02)
FAX - (916) 324-5872
Type of SLN: [ ] First-Party or [ ] Third-Party
It is recognized that the issuance of a SLN does not constitute a recommendation by the California Department of
Pesticide Regulation or relieve the user of any responsibility. USE ADDITIONAL PAGES IF NECESSARY.
Give a complete description of the problem. Also, submit evidence such as field data, copies of published articles, or
written statements by qualified experts that the special local need exists.
List any other products that are registered in California for this use. Give reasons why these alternatives are not
available or are not effective in controlling the pest(s).
For what similar use is the product registered?
Will the crop be marketed fresh or processed?
What, if any, are the anticipated hazards to bees, fish, wildlife or any nontarget organisms?
What will be the total amount of acreage treated? (estimate)
Has a residue tolerance been established for the food or feed crop?
ADDITIONAL REQUIREMENTS NECESSARY FOR THE ISSUANCE OF A SLN
1. A copy of the U.S. EPA Federal SLN, EPA Form 8570-25, signed by the proposed registrant.
2. Efficacy and phytotoxicity data: If the use is on a food crop, residue data is also required.
3. A letter of authorization from the manufacturer.
Page 1 of 2
STATE OF CALIFORNIA
REQUEST FOR A SPECIAL LOCAL NEED
REGISTRATION (SLN), SECTION 24(c)
PR-REG-004 (Est. 7/91)(Rev. 05/02)
THE PROPOSED LABEL
Product Name: ______________________________________
U.S. EPA Reg. No. _________________________
Manufacturer: __________________________________
Location: _________________________________
Crop/Commodity/Site: _______________________________
Pest(s): ___________________________________
Proposed Dosage: __________________________
Proposed Dilution Rate: ____________________
Method of Application: ___________________
Frequency/Timing of Application:______________________________
Proposed Restricted Entry Interval (REI): __________________
Proposed Preharvest Interval (PHI): _________
Other Special Requirements:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Name and Address of the SLN Registrant:
________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Contact Person: _____________________________________
Telephone Number: _______________________
_________________________________________________________________________________________________
Signature
Date
_________________________________________________________________________________________________
Signature of County Agricultural Commissioner (Approval for Permit if Necessary)
Return This Form to:
Department of Pesticide Regulation
Pesticide Registration Branch
1001 I Street
Sacramento, California 95812-4015
(916) 445-4400; fax: (916) 324-5872
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