Form PR-ENF-102 "Pesticide Pre-application Site Evaluation" - California

What Is Form PR-ENF-102?

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 January 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 PR-ENF-102 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-ENF-102 "Pesticide Pre-application Site Evaluation" - California

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STATE OF CALIFORNIA
102-
DEPARTMENT OF PESTICIDE REGULATION
PESTICIDE PRE-APPLICATION SITE EVALUATION
PR-ENF-102 (REV. 01/10) Page 1 of 1
EVALUATING COUNTY
TELEPHONE NUMBER
OPERATOR OF THE PROPERTY EVALUATED
MAILING ADDRESS
PROPERTY LOCATION
PERMIT / OPERATOR ID NUMBER
PEST CONTROL BUSINESS
COMMODITY / SITE
METHOD OF APPLICATION (CHECK ONE)
SITE ID NUMBER
AERIAL
FUME
CHEMIGATION
HAND HELD
GROUND RIG
OTHER
PCA LICENSE NUMBER
BASIS FOR APPLICATION EVALUATED
PCA EMPLOYER
YES
NO
(6436, 6426(a))
YES
NO
WRITTEN RECOMMENDATION
REQUESTED
N/A
PCA NAME
PCA REGISTERED IN COUNTY
(12002)
(12004)
YES
NO
YES
NO
N/A
PROVIDED
PROPOSED APPLICATION DATE AND TIME
PCA RECOMMENDATION NUMBER
COMPLIANCE
Section
REQUIREMENTS
N
YES
NO
N/A
1. Notice of Intent Complete /
6434
Consistent with Permit
2. Proposed Application Complies with
12973
Permit Conditions
3. Environment Consistent with Permit
TREATMENT
W
E
6428(c)
AREA
Notice of Intent
4. Proposed Application Consistent
with Restricted Material Regulations 6443 - 6487.5
S
TOTAL
TOTAL
ENVIRONMENTAL HAZARDS
LABEL REGISTRATION NUMBER
SIGNAL WORD
FORM
RATE
DILUTION
PESTICIDE NAME / MANUFACTURER
Remarks - Include a detailed description of noncompliances. When additional space is required, continue on Inspection Report / VN Supplement, PR-ENF-111.
INSPECTOR (Print Name)
Signature
DATE AND TIME EVALUATED
DATE ACKNOWLEDGED
EVALUATION ACKNOWLEDGED BY (Print Name)
Signature
APPLICATOR NOTIFIED (WHEN APPLICATION IS DENIED)
NOTIFICATION METHOD________________________________________________________________
DATE_________________________ TIME_________________________
Distribution: White - County; Pink - Inspector; Goldenrod - Firm / Person Inspected
Page
of
STATE OF CALIFORNIA
102-
DEPARTMENT OF PESTICIDE REGULATION
PESTICIDE PRE-APPLICATION SITE EVALUATION
PR-ENF-102 (REV. 01/10) Page 1 of 1
EVALUATING COUNTY
TELEPHONE NUMBER
OPERATOR OF THE PROPERTY EVALUATED
MAILING ADDRESS
PROPERTY LOCATION
PERMIT / OPERATOR ID NUMBER
PEST CONTROL BUSINESS
COMMODITY / SITE
METHOD OF APPLICATION (CHECK ONE)
SITE ID NUMBER
AERIAL
FUME
CHEMIGATION
HAND HELD
GROUND RIG
OTHER
PCA LICENSE NUMBER
BASIS FOR APPLICATION EVALUATED
PCA EMPLOYER
YES
NO
(6436, 6426(a))
YES
NO
WRITTEN RECOMMENDATION
REQUESTED
N/A
PCA NAME
PCA REGISTERED IN COUNTY
(12002)
(12004)
YES
NO
YES
NO
N/A
PROVIDED
PROPOSED APPLICATION DATE AND TIME
PCA RECOMMENDATION NUMBER
COMPLIANCE
Section
REQUIREMENTS
N
YES
NO
N/A
1. Notice of Intent Complete /
6434
Consistent with Permit
2. Proposed Application Complies with
12973
Permit Conditions
3. Environment Consistent with Permit
TREATMENT
W
E
6428(c)
AREA
Notice of Intent
4. Proposed Application Consistent
with Restricted Material Regulations 6443 - 6487.5
S
TOTAL
TOTAL
ENVIRONMENTAL HAZARDS
LABEL REGISTRATION NUMBER
SIGNAL WORD
FORM
RATE
DILUTION
PESTICIDE NAME / MANUFACTURER
Remarks - Include a detailed description of noncompliances. When additional space is required, continue on Inspection Report / VN Supplement, PR-ENF-111.
INSPECTOR (Print Name)
Signature
DATE AND TIME EVALUATED
DATE ACKNOWLEDGED
EVALUATION ACKNOWLEDGED BY (Print Name)
Signature
APPLICATOR NOTIFIED (WHEN APPLICATION IS DENIED)
NOTIFICATION METHOD________________________________________________________________
DATE_________________________ TIME_________________________
Distribution: White - County; Pink - Inspector; Goldenrod - Firm / Person Inspected
Page
of