Form DPR-ENF-220 "Fumigant Management Plan (Field Fumigation)" - California

What Is Form DPR-ENF-220?

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 December 1, 2010;
  • 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-ENF-220 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-ENF-220 "Fumigant Management Plan (Field Fumigation)" - California

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STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
FUMIGANT MANAGEMENT PLAN
ENFORCEMENT BRANCH
(FIELD FUMIGATION)
PAGE ______ OF ______
DPR-ENF-220 (NEW 12-10) PAGE 1
A. Supervising Certified Applicator On-Site
NAME
GROWER EMPLOYEE CERTIFICATE NUMBER
INDIVIDUAL LICENSE NUMBER
PEST CONTROL BUSINESS NAME
PEST CONTROL BUSINESS LICENSE NUMBER
CONTACT INFORMATION ON PERMIT / NOI?
YES
B. Operator of the Property
NAME
PERMIT NUMBER
CONTACT INFORMATION IN PERMIT / NOI?
YES
C. General Application Information
PRODUCT NAME
U.S. EPA REGISTRATION NUMBER
TARGET DATE
WINDOW
SITE IDENTIFICATION NUMBER
MAP AND SITE INFORMATION ON PERMIT?
BLOCK NUMBER
YES
APPLICATION METHOD (Mark as applicable)
FLOOD
SPRINKLER*
SPRAY BLADE DEPTH (Inches)___________
DRIP DEPTH (Inches)________________
SHANK DEPTH (Inches)_______________
ROTARY TILL DEPTH (Inches)____________
OTHER (Specify)____________________
DRENCH
WATER PRESSURE (Pounds per square inch)
NOZZLE SIZE
LENGTH / LINE
IRRIGATION RATE (Inches / hr.)
IRRIGATION SET NUMBER
ACRES TREATED / SET
LINES / SET
TREATMENT TYPE (Mark as applicable)
BROADCAST (Entire field)
ROWS (Flat fume)
STRIP
RAISED BEDS
TREE HOLES
OTHER________________________________________________________________________
FUMIGANT CONTAINMENT (Mark as applicable)
OTHER________________________________________________________________________
COMPACTION
TARP
SOIL CAP
WATER (Attach post-application water treatment table)
SOIL COMPACTION (Mark as applicable)
DISC & ROLLER
DRAG PIPE
PRESS SEALER
SHOVELS & ROLLER
CULTIPACKER & DISC
OTHER________________________________________________________________________
WHEN SENSORY IRRITATION IS EXPERIENCED, OPERATIONS WILL:
CEASE; PERSONNEL WILL BE WITHDRAWN FROM THE SITE
CONTINUE WITH HANDLERS WEARING AIR-PURIFYING RESPIRATORS
WHEN NECESSARY, AIR MONITORING WILL BE PERFORMED BY__________________________________________________________ (Address and telephone number available on file)
WHEN NECESSARY, THE FOLLOWING REPRESENTATIVE HANDLER TASKS WILL BE MONITORED
THE FOLLOWING MONITORING EQUIPMENT WILL BE USED
THE TIMING OF THE MONITORING THAT WILL BE PERFORMED IS AS FOLLOWS
D. Tarps Used
YES
NO
TARP TYPE (Mark as applicable)
HIGH BARRIER
TOTALLY IMPERMEABLE (TIF)
VIRTUALLY IMPERMEABLE (VIF)
SEMI-VIRTUALLY IMPERMEABLE (SIF)
HIGH-DENSITY POLYETHYLENE
OTHER (Specify)
(HDPE)
THICKNESS
TARP CHECK SCHEDULE
LOT NUMBER
TARP REPAIRS BY
RESPONSE TIME
MINIMUM SIZE TO BE REPAIRED
MINIMUM TIME AFTER APPLICATION TARPS WILL BE REPAIRED
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
FUMIGANT MANAGEMENT PLAN
ENFORCEMENT BRANCH
(FIELD FUMIGATION)
PAGE ______ OF ______
DPR-ENF-220 (NEW 12-10) PAGE 1
A. Supervising Certified Applicator On-Site
NAME
GROWER EMPLOYEE CERTIFICATE NUMBER
INDIVIDUAL LICENSE NUMBER
PEST CONTROL BUSINESS NAME
PEST CONTROL BUSINESS LICENSE NUMBER
CONTACT INFORMATION ON PERMIT / NOI?
YES
B. Operator of the Property
NAME
PERMIT NUMBER
CONTACT INFORMATION IN PERMIT / NOI?
YES
C. General Application Information
PRODUCT NAME
U.S. EPA REGISTRATION NUMBER
TARGET DATE
WINDOW
SITE IDENTIFICATION NUMBER
MAP AND SITE INFORMATION ON PERMIT?
BLOCK NUMBER
YES
APPLICATION METHOD (Mark as applicable)
FLOOD
SPRINKLER*
SPRAY BLADE DEPTH (Inches)___________
DRIP DEPTH (Inches)________________
SHANK DEPTH (Inches)_______________
ROTARY TILL DEPTH (Inches)____________
OTHER (Specify)____________________
DRENCH
WATER PRESSURE (Pounds per square inch)
NOZZLE SIZE
LENGTH / LINE
IRRIGATION RATE (Inches / hr.)
IRRIGATION SET NUMBER
ACRES TREATED / SET
LINES / SET
TREATMENT TYPE (Mark as applicable)
BROADCAST (Entire field)
ROWS (Flat fume)
STRIP
RAISED BEDS
TREE HOLES
OTHER________________________________________________________________________
FUMIGANT CONTAINMENT (Mark as applicable)
OTHER________________________________________________________________________
COMPACTION
TARP
SOIL CAP
WATER (Attach post-application water treatment table)
SOIL COMPACTION (Mark as applicable)
DISC & ROLLER
DRAG PIPE
PRESS SEALER
SHOVELS & ROLLER
CULTIPACKER & DISC
OTHER________________________________________________________________________
WHEN SENSORY IRRITATION IS EXPERIENCED, OPERATIONS WILL:
CEASE; PERSONNEL WILL BE WITHDRAWN FROM THE SITE
CONTINUE WITH HANDLERS WEARING AIR-PURIFYING RESPIRATORS
WHEN NECESSARY, AIR MONITORING WILL BE PERFORMED BY__________________________________________________________ (Address and telephone number available on file)
WHEN NECESSARY, THE FOLLOWING REPRESENTATIVE HANDLER TASKS WILL BE MONITORED
THE FOLLOWING MONITORING EQUIPMENT WILL BE USED
THE TIMING OF THE MONITORING THAT WILL BE PERFORMED IS AS FOLLOWS
D. Tarps Used
YES
NO
TARP TYPE (Mark as applicable)
HIGH BARRIER
TOTALLY IMPERMEABLE (TIF)
VIRTUALLY IMPERMEABLE (VIF)
SEMI-VIRTUALLY IMPERMEABLE (SIF)
HIGH-DENSITY POLYETHYLENE
OTHER (Specify)
(HDPE)
THICKNESS
TARP CHECK SCHEDULE
LOT NUMBER
TARP REPAIRS BY
RESPONSE TIME
MINIMUM SIZE TO BE REPAIRED
MINIMUM TIME AFTER APPLICATION TARPS WILL BE REPAIRED
FUMIGANT MANAGEMENT PLAN
(FIELD FUMIGATION)
PAGE ______ OF ______
DPR-ENF-220 (NEW 12-10) PAGE 2
D. Tarps Used (Continued)
FACTORS THAT DETERMINE WHEN TARP WILL BE REPAIRED
PERSON RESPONSIBLE FOR CUTTING TARPS
TELEPHONE NUMBER (Include Area Code) PERSON RESPONSIBLE FOR REPAIRING TARPS
TELEPHONE NUMBER (Include Area Code)
TARP CUTTING METHOD
CUTTING SCHEDULE / TARGET DATE
TARP REMOVAL METHOD
REMOVAL SCHEDULE / TARGET DATE
E. Weather Conditions (Immediately prior to application)
COPY OF WEATHER FORECAST FOR THE DAY OF APPLICATION AND 48 HOURS AFTER APPLICATION
WIND SPEED (MPH)
WIND DIRECTION
AIR TEMP. (°F)
(INCLUDING INVERSION CONDITIONS AND ANY AIR STAGNATION ADVISORY) ATTACHED
YES
F. Soil Conditions (Immediately prior to application)
SOIL MOISTURE / DEPTH
SOIL MOISTURE METHOD USED
SOIL TEXTURE
SOIL TEMPERATURE °F / DEPTH
G. Respiratory Program -- Written Respiratory Program Document on File
YES
H. Posting
PERSON POSTING SIGNS
POSTING WILL CONFORM TO 3 CCR SECTION 6776
YES
I. Hazard Communication
ON-SITE COMMUNICATION AND HAZARD COMMUNICATION WILL CONFORM TO
MSDS FOR ALL PESTICIDES APPLIED WILL BE AVAILABLE ON-SITE
3 CCR SECTIONS 6618, 6619, 6723, AND 6723.1 AND THIS FUMIGATION PLAN
YES
YES
J. Other Good Agricultural Practices
DESCRIPTION OF ALL OTHER APPLICABLE GOOD AGRICULTURAL PRACTICES (GAP)
DESCRIPTION OF MEASUREMENTS AND DOCUMENTATION ENSURING THAT GAPS ARE ACHIEVED
FUMIGANT MANAGEMENT PLAN
(FIELD FUMIGATION)
PAGE ______ OF ______
DPR-ENF-220 (NEW 12-10) PAGE 3
K. Emergency Procedures
"IN CASE OF EMERGENCY" CONTACT (NAMES AND TELEPHONE NUMBERS, Include Area Code)
9-1-1
OPERATOR __________________________________________________
CERTIFIED APPLICATOR __________________________________________________
CAC __________________________________________________________________________
OTHER ________________________________________________________________
ON-SITE TELEPHONE LOCATION
EVACUATION ROUTES
EMERGENCY PROCEDURES
L. Attachments (List ALL Attachments)
MINIMUM REQUIRED --
WEATHER FORECAST
AUTHORIZED ON-SITE PERSONNEL
POST-APPLICATION SUMMARY
OTHER
I verify that the information provided in this Fumigant Management Plan and its attachments accurately reflect the actual conditions associated
with this application. I certify that I will maintain this record and make it available for inspection for two years from the date of the application.
______________________________________________________________________________
___________________________________________
SIGNATURE OF CERTIFIED APPLICATOR SUPERVISING APPLICATION
DATE
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