Form DPR-REG-033 "Request for Voluntary Cancellation of Pesticide Product Registration" - California

What Is Form DPR-REG-033?

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 April 1, 2017;
  • 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;
  • Fill out the form in our online filing application.

Download a fillable version of Form DPR-REG-033 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 DPR-REG-033 "Request for Voluntary Cancellation of Pesticide Product Registration" - California

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State of California
Department of Pesticide Regulation
REQUEST FOR VOLUNTARY CANCELLATION
OF PESTICIDE PRODUCT REGISTRATION
DPR-REG-033 (Rev. 04/17)
Page 1 of 1
DPR USE ONLY
REQUEST FOR VOLUNTARY CANCELLATION
OF PESTICIDE PRODUCT REGISTRATION
I hereby request voluntary cancellation of the listed pesticide product registration(s) in California, effective immediately. I
understand that by voluntarily cancelling my product registration(s) in accordance with Food and Agriculture Code
section 12828.5, I am waiving my right to a hearing regarding cancellation(s) of the pesticide product registration(s).
Pursuant to California Code of Regulations section 6301(b), once a pesticide product is no longer registered it may not be
sold in California by the registrant, but may be possessed and sold by a dealer for two years after the last date of
registration.
Company Name
U.S. EPA or California
Product Brand Name
Registration Number
Submit completed form to:
Department of Pesticide Regulation
Pesticide Registration Branch
Attn: Licensing Unit
Signature
Date
P.O. Box 4015
Sacramento, California 95812-4015
- OR -
PRBLicensingMail@cdpr.ca.gov
Type or Print Name and Title
State of California
Department of Pesticide Regulation
REQUEST FOR VOLUNTARY CANCELLATION
OF PESTICIDE PRODUCT REGISTRATION
DPR-REG-033 (Rev. 04/17)
Page 1 of 1
DPR USE ONLY
REQUEST FOR VOLUNTARY CANCELLATION
OF PESTICIDE PRODUCT REGISTRATION
I hereby request voluntary cancellation of the listed pesticide product registration(s) in California, effective immediately. I
understand that by voluntarily cancelling my product registration(s) in accordance with Food and Agriculture Code
section 12828.5, I am waiving my right to a hearing regarding cancellation(s) of the pesticide product registration(s).
Pursuant to California Code of Regulations section 6301(b), once a pesticide product is no longer registered it may not be
sold in California by the registrant, but may be possessed and sold by a dealer for two years after the last date of
registration.
Company Name
U.S. EPA or California
Product Brand Name
Registration Number
Submit completed form to:
Department of Pesticide Regulation
Pesticide Registration Branch
Attn: Licensing Unit
Signature
Date
P.O. Box 4015
Sacramento, California 95812-4015
- OR -
PRBLicensingMail@cdpr.ca.gov
Type or Print Name and Title