"Grain Inspectors - Application Form" - Delaware

The Delaware Department of Agriculture has released this version of the "Grain Inspectors - Application Form" on February 20, 2009.

This form may be used by all Delaware residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Download "Grain Inspectors - Application Form" - Delaware

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DELAWARE DEPARTMENT OF AGRICULTURE
PLANT INDUSTRIES SECTION
2320 S. DUPONT HIGHWAY
DOVER, DELAWARE 19901-5515
Phone: (302) 698-4577
(800) 282-8685
GRAIN INSPECTORS -- APPLICATION
Applicant:
Address:
City/State/Zip
Business:
Address:
City/State/Zip
Length of Employment with this firm: __________
Experience with equipment: ____________________
TYPE OF GRAIN:
GRADE FACTORS
(check box)
(check box )
CORN:
Moisture
TW
BCFM
TD
other
SOYBEANS:
Moisture
TW
FM
TD
other
BARLEY:
Moisture
TW
DKG
GAR
TD
FM
SKBN
other
WHEAT:
Moisture
TW
DKG
GAR
TD
FM
THIN
other
SORGHUM:
Moisture
TW
DKG
other
GAC 2500
GAC 2000
GAC 2100
OTHER: ______________________
MOISTURE DEVICE:
Secure the endorsement of three persons to the following certifications;
The undersigned is acquainted with the applicant and hereby certifies him/her to be of good moral charter.
Signature
Address
_______________________________________
__________________________________________________
_______________________________________
__________________________________________________
_______________________________________
__________________________________________________
A $10.00 fee for two (2) years must accompany application for grain inspectors. All licenses must be returned to
the Delaware Department of Agriculture within 30 days of termination of employment.
I agree to comply with all the requirements of the Grain Inspection Rules and Regulations.
____________________________________
Signature of Applicant
Date
PAYMENT:
CHECK:
Amount $
CHECK NO:
Please Make Check Payable To: Delaware Department of Agriculture Seed Laboratory
Charge to my Credit Card: Amount $__________
VISA
MASTER CARD
DISCOVER/NOVUS
Card Number:
Exp Date: ______/_____ 3-Digit Code:
Billing Name:
Telephone No:.
Billing Address:
City/State/Zip:
Authorization Signature:
Date:
OFFICE USE ONLY
PAYMENT
CASH
CHECK NO
CREDIT
INVOICE NO
POSTED
ISPECTORS APPLICATION.09.02.20.RCB.WEB
DELAWARE DEPARTMENT OF AGRICULTURE
PLANT INDUSTRIES SECTION
2320 S. DUPONT HIGHWAY
DOVER, DELAWARE 19901-5515
Phone: (302) 698-4577
(800) 282-8685
GRAIN INSPECTORS -- APPLICATION
Applicant:
Address:
City/State/Zip
Business:
Address:
City/State/Zip
Length of Employment with this firm: __________
Experience with equipment: ____________________
TYPE OF GRAIN:
GRADE FACTORS
(check box)
(check box )
CORN:
Moisture
TW
BCFM
TD
other
SOYBEANS:
Moisture
TW
FM
TD
other
BARLEY:
Moisture
TW
DKG
GAR
TD
FM
SKBN
other
WHEAT:
Moisture
TW
DKG
GAR
TD
FM
THIN
other
SORGHUM:
Moisture
TW
DKG
other
GAC 2500
GAC 2000
GAC 2100
OTHER: ______________________
MOISTURE DEVICE:
Secure the endorsement of three persons to the following certifications;
The undersigned is acquainted with the applicant and hereby certifies him/her to be of good moral charter.
Signature
Address
_______________________________________
__________________________________________________
_______________________________________
__________________________________________________
_______________________________________
__________________________________________________
A $10.00 fee for two (2) years must accompany application for grain inspectors. All licenses must be returned to
the Delaware Department of Agriculture within 30 days of termination of employment.
I agree to comply with all the requirements of the Grain Inspection Rules and Regulations.
____________________________________
Signature of Applicant
Date
PAYMENT:
CHECK:
Amount $
CHECK NO:
Please Make Check Payable To: Delaware Department of Agriculture Seed Laboratory
Charge to my Credit Card: Amount $__________
VISA
MASTER CARD
DISCOVER/NOVUS
Card Number:
Exp Date: ______/_____ 3-Digit Code:
Billing Name:
Telephone No:.
Billing Address:
City/State/Zip:
Authorization Signature:
Date:
OFFICE USE ONLY
PAYMENT
CASH
CHECK NO
CREDIT
INVOICE NO
POSTED
ISPECTORS APPLICATION.09.02.20.RCB.WEB
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