"Application for New Registration of 25(B) Products" - Alabama

Application for New Registration of 25(B) Products is a legal document that was released by the Alabama Department of Agriculture and Industries - a government authority operating within Alabama.

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STATE OF ALABAMA
DEPARTMENT OF AGRICULTURE & INDUSTRIES
Application for NEW REGISTRATION of 25(b) Products
For the year ending December 31, 20
See Pages 2-3 for complete instructions
Pursuant to Section 2-27-9, Code of Alabama, (1975), the undersigned hereby submits application for registration of the following pesticide products:
1.
:
C
,
/
A
OMPANY OFFERING PRODUCT FOR SALE
AND
OR TRANSPORT WITHIN
LABAMA
Company Name:
Physical Address:
_______________________________________City:_____________ State:____Zip:___________
Mailing Address:
_______________________________________City:_____________State:____Zip:___________
Phone #(
) ______________
Fax #(
)
2.
:
M
C
N
ANUFACTURER
OMPANY
AME
Physical Address:
City:
State:
Zip:
Mailing Address:
City:
State:
Zip:
Phone #(
)
Fax #(
)
:
3.
P
D
RODUCT
ISTRIBUTED BY
Company Name:
Physical Address:
City:
State:
Zip:
Mailing Address:
City:
State:
Zip:
Phone #(
)
Fax #(
)
4.
C
A
R
& M
OMPANY OR
GENCY RESPONSIBLE FOR PRODUCT
ENEWALS
AINTENANCE
* P.O.C. = Point of Contact FORM REQUIRED!
Company Name:
Name of Liaison/*P.O.C. First
Last
Title
Physical Address:
City:
State:
Zip:
Mailing Address:
City:
State:
Zip:
Phone #(
)
Fax #(
)
(FOR DEPT. USE ONLY)
D
. ID #
5.
P
N
:
EPT
RODUCT
AME
6.
L
A
I
AND I
P
:
IST EACH
CTIVE
NGREDIENT
NCLUDE
ERCENTAGES
%
%
%
%
7.
L
ALL I
/O
I
:
IST
NERT
THER
NGREDIENTS
Total % of Inert/Other:
Y
N
8. D
?
ES
O
OES THE PRODUCT LABEL REFERENCE COMPANY WEBSITE
Website address:
The undersigned hereby certifies that the information given on this application together with any additional form is true and correct according
to the best of his/her knowledge and belief.
Name/Title ____________________________ _________________________________
Please Print Name
Point of Contact Signature
***********************************PLEASE DO NOT WRITE BELOW THIS LINE***********************************************
This certifies that the registration fee has been paid for the above named pesticide product(s) and such are duly registered for sale in the State
of Alabama in compliance with the requirements of the pesticide law for Year Ending December 31, 20______
Date:____________ ______________________________________________ Check No:_________ Transmittal No:______
Tony L. Cofer, Program Director
Data Entry Completed:_________________ By:____________ Label(s)
MSDS(s)
Confirmation Mailed:__________________ By:____________
STATE OF ALABAMA
DEPARTMENT OF AGRICULTURE & INDUSTRIES
Application for NEW REGISTRATION of 25(b) Products
For the year ending December 31, 20
See Pages 2-3 for complete instructions
Pursuant to Section 2-27-9, Code of Alabama, (1975), the undersigned hereby submits application for registration of the following pesticide products:
1.
:
C
,
/
A
OMPANY OFFERING PRODUCT FOR SALE
AND
OR TRANSPORT WITHIN
LABAMA
Company Name:
Physical Address:
_______________________________________City:_____________ State:____Zip:___________
Mailing Address:
_______________________________________City:_____________State:____Zip:___________
Phone #(
) ______________
Fax #(
)
2.
:
M
C
N
ANUFACTURER
OMPANY
AME
Physical Address:
City:
State:
Zip:
Mailing Address:
City:
State:
Zip:
Phone #(
)
Fax #(
)
:
3.
P
D
RODUCT
ISTRIBUTED BY
Company Name:
Physical Address:
City:
State:
Zip:
Mailing Address:
City:
State:
Zip:
Phone #(
)
Fax #(
)
4.
C
A
R
& M
OMPANY OR
GENCY RESPONSIBLE FOR PRODUCT
ENEWALS
AINTENANCE
* P.O.C. = Point of Contact FORM REQUIRED!
Company Name:
Name of Liaison/*P.O.C. First
Last
Title
Physical Address:
City:
State:
Zip:
Mailing Address:
City:
State:
Zip:
Phone #(
)
Fax #(
)
(FOR DEPT. USE ONLY)
D
. ID #
5.
P
N
:
EPT
RODUCT
AME
6.
L
A
I
AND I
P
:
IST EACH
CTIVE
NGREDIENT
NCLUDE
ERCENTAGES
%
%
%
%
7.
L
ALL I
/O
I
:
IST
NERT
THER
NGREDIENTS
Total % of Inert/Other:
Y
N
8. D
?
ES
O
OES THE PRODUCT LABEL REFERENCE COMPANY WEBSITE
Website address:
The undersigned hereby certifies that the information given on this application together with any additional form is true and correct according
to the best of his/her knowledge and belief.
Name/Title ____________________________ _________________________________
Please Print Name
Point of Contact Signature
***********************************PLEASE DO NOT WRITE BELOW THIS LINE***********************************************
This certifies that the registration fee has been paid for the above named pesticide product(s) and such are duly registered for sale in the State
of Alabama in compliance with the requirements of the pesticide law for Year Ending December 31, 20______
Date:____________ ______________________________________________ Check No:_________ Transmittal No:______
Tony L. Cofer, Program Director
Data Entry Completed:_________________ By:____________ Label(s)
MSDS(s)
Confirmation Mailed:__________________ By:____________
A
P
F
C
P
S
E
F
F
I
, F
,
LABAMA
OLICY
OR
ERTAIN
ESTICIDE
UBSTANCES
XEMPT
ROM
EDERAL
NSECTICIDE
UNGICIDE
R
A
[FIFRA
25(
)]
AND
ODENTICIDE
CT
SECTION
B
: It is your responsibility to determine if your product qualifies as 25(b)
PRIOR TO SUBMISSION
Effective May 6, 1996 the Environmental Protection Agency (EPA) exempted products containing thirty-one (31)
pesticidal active ingredients and one hundred sixty (160) inert ingredients from FIFRA regulation. EPA concluded
exemption of these products would not pose unreasonable risks to public health or the environment.
This federal rule also allows states such as Alabama, whose pesticide laws do not allow for such exemptions, to
continue enforcement of their state provisions. As such, the following conditions must be met in order to
market in Alabama those pesticide products subject to FIFRA section 25(b):
1. Each product brand name (including alternate brand names) must be registered.
2. The words: ‘EPA EXEMPTED PRODUCT’ must appear on each Alabama Application For New Pesticide
Product Registration Form.
3. Final printed labels must not bear EPA registration numbers.
4. ‘Active’ ingredients must be listed in 40 Code of Federal Regulations (CFR) 152.25(g) as exempt from
the requirement for federal registration. ‘Inert’ or ‘Other’ ingredients must be listed on EPA Inerts
List 4A (40 CFR 180.950).
5. Under the heading of ‘Active Ingredients,’ each product must bear a final printed label identifying
the name and percentage by weight of each active ingredient. Under the heading of ‘Inert or Other
Ingredients,’ each inert or other ingredient must also be listed by name. The inert or other
ingredients must be shown as one (1) total percentage for all inert or other ingredients combined.
The combined percentages of active and inert or other ingredients must equal 100%.
6. A statement that product is EPA exempt must appear on the label. Examples of label wording are as
follows:
a. “This 25(b) product is exempt from registration with the Federal Environmental Protection
Agency under FIFRA regulations”
b. “This product has not been registered by the United States Environmental Protection
Agency. [The name of Company] represents that this product qualifies for exemption from
registration under FIFRA”
d. Or, an acceptable equivalent that will be reviewed and accepted by Alabama prior to the
labels final printing.
7. The product must not include any false or misleading labeling statements, including those listed in
40 CFR 156.10(a)(5)(i) through (viii).
8. The product must not bear claims to either control or mitigate microorganisms that pose a threat to
human health, including but not limited to disease transmitting bacteria or viruses, or claims to
control insects or rodents carrying specific disease, including but not limited to ticks that carry Lyme
disease.
9. Product(s) which bear EPA registration numbers and are presently in Alabama’s trade channels will
continue to fall under FIFRA regulation.
PRIOR TO
SUBMISSION: Please ensure that you have visited EPA’s website on 25(b) criteria at:
www.epa.gov/oppbppd1/biopesticides/regtools/25b_list.htm
Review both the ACTIVE and the INERTS lists. It is your responsibility to determine if your product qualifies as
25(b).
Check list of required support
documents:
 Final product label, as seen in the marketplace
 MSDS
 Efficacy Data (when required)
 Check or Money Order made out to the Alabama Department of
Agriculture & Industries in the amount of $
*Please contact our office prior to submission for registration fee schedule
Registration Point of Contact:
David Petty 334-240-7244
david.petty@agi.alabama.gov
MAIL COMPLETED APPLICATION, LABELS WITH REQUIRED INFORMATION & REGISTRATION FEE(S) TO:
ALABAMA DEPARTMENT OF AGRICULTURE & INDUSTRIES
PESTICIDE REGISTRATION SECTION
1445 FEDERAL DRIVE
MONTGOMERY AL 36109-0336
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