Form FDACS-13630 "Licensee Inspection Pest Control Business" - Florida

Form FDACS-13630 or the "Licensee Inspection Pest Control Business" is a form issued by the Florida Department of Agriculture and Consumer Services.

The form was last revised in October 1, 2015 and is available for digital filing. Download an up-to-date Form FDACS-13630 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

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Download Form FDACS-13630 "Licensee Inspection Pest Control Business" - Florida

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Florida Department of Agriculture and Consumer Services
Submit to:
Division of Agricultural Environmental Services
Bureau of Inspection and
Incident Response
3125 Conner Blvd, Suite N,
LICENSEE INSPECTION PEST CONTROL BUSINESS
Tallahassee FL 32399-1650
Rule 5E-14.1025, F.A.C.
ADAM H. PUTNAM
Telephone: (850) 617-7996
COMMISSIONER
I. FIRM INSPECTED
DATE: ___________________
_______________________________________________________________________________________________________________
(NAME)
(BUSINESS LICENSE NO.)
_____________________________________________________________________________________________________________________________
(STREET ADDRESS)
(CITY)
(COUNTY)
(ZIP CODE)
_____________________________________________________________________________________________________________________________
(C.O. IN CHARGE)
(CERTIFICATE NO.)
(CATEGORIES)
_____________________________________________________________________________________________________________________________
(PERSON INTERVIEWED)
(TITLE/POSITION)
II.
PESTICIDES:
1.
Are there canceled, suspended or unregistered pesticides present?
(If yes, explain in detail) _________________________________________
____________________________________________________________________________________________________________________________
2.
Are pesticides stored in accordance with label directions?
_____________________________________________________________________
3.
Are there pesticides present that are out of category of licensee?
(If yes, explain in detail) ___________________________________________
___________________________________________________________________________________________________________________________
4.
Are Restricted Use Pesticides used by this firm?
_____________________________________________________________________________
5.
Are Restricted Use Pesticide records kept according to regulations?
____________________________________________________________
III. WORKER SAFETY
e
1.
Personal protective equipment (PPE) required by label availabl
?
______________________________________________________________
IV. DISPOSAL:
1.
How are pesticide containers disposed of?
__________________________________________________________________________________
_____________________________________________________________________________________________________________________________
2.
What is done with excess container rinsate?
________________________________________________________________________________
____________________________________________________________________________________________________________________________
3.
What is done with excess sprays and equipment rinsates?
____________________________________________________________________
Describe the firm’s spill control procedure.
4.
___________________________________________________________________________________
Violations Observed:
_________________________________________________________________________________
___________________________________________________________________________________________________
Documentation Obtained:
_____________________________________________________________________________________________________
Comments:
__________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
(Signature of Company Representative)
(Field Inspector)
FDACS-13630 Rev. 10/15
Florida Department of Agriculture and Consumer Services
Submit to:
Division of Agricultural Environmental Services
Bureau of Inspection and
Incident Response
3125 Conner Blvd, Suite N,
LICENSEE INSPECTION PEST CONTROL BUSINESS
Tallahassee FL 32399-1650
Rule 5E-14.1025, F.A.C.
ADAM H. PUTNAM
Telephone: (850) 617-7996
COMMISSIONER
I. FIRM INSPECTED
DATE: ___________________
_______________________________________________________________________________________________________________
(NAME)
(BUSINESS LICENSE NO.)
_____________________________________________________________________________________________________________________________
(STREET ADDRESS)
(CITY)
(COUNTY)
(ZIP CODE)
_____________________________________________________________________________________________________________________________
(C.O. IN CHARGE)
(CERTIFICATE NO.)
(CATEGORIES)
_____________________________________________________________________________________________________________________________
(PERSON INTERVIEWED)
(TITLE/POSITION)
II.
PESTICIDES:
1.
Are there canceled, suspended or unregistered pesticides present?
(If yes, explain in detail) _________________________________________
____________________________________________________________________________________________________________________________
2.
Are pesticides stored in accordance with label directions?
_____________________________________________________________________
3.
Are there pesticides present that are out of category of licensee?
(If yes, explain in detail) ___________________________________________
___________________________________________________________________________________________________________________________
4.
Are Restricted Use Pesticides used by this firm?
_____________________________________________________________________________
5.
Are Restricted Use Pesticide records kept according to regulations?
____________________________________________________________
III. WORKER SAFETY
e
1.
Personal protective equipment (PPE) required by label availabl
?
______________________________________________________________
IV. DISPOSAL:
1.
How are pesticide containers disposed of?
__________________________________________________________________________________
_____________________________________________________________________________________________________________________________
2.
What is done with excess container rinsate?
________________________________________________________________________________
____________________________________________________________________________________________________________________________
3.
What is done with excess sprays and equipment rinsates?
____________________________________________________________________
Describe the firm’s spill control procedure.
4.
___________________________________________________________________________________
Violations Observed:
_________________________________________________________________________________
___________________________________________________________________________________________________
Documentation Obtained:
_____________________________________________________________________________________________________
Comments:
__________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
(Signature of Company Representative)
(Field Inspector)
FDACS-13630 Rev. 10/15
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