"Annual Pesticide Summary" - Newfoundland and Labrador, Canada

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Government of Newfoundland and Labrador
Department of Municipal Affairs and Environment
Privacy Notice
Under the authority of the Environmental Protection Act SNL 2002 cE-14.2, personal
information will be collected for the purpose of enforcing the Pesticides Control Regulations
2012. This allows the Department of Municipal Affairs and Environment to disclose personal
information to other Federal and Provincial Departments and Agencies.
Annual Pesticide Summary
Company Name: _______________________________________________________
Pesticide Operator Licence #:_______________
Year ending December 31, ________
Name of company/companies from whom you purchased pesticides:
_______________________________________________
_______________________________________________
_______________________________________________
Pesticide Trade
Quantity
Quantity
PCP #
Classification
Name
Purchased
Used
I hereby certify that the information provided in this application is accurate, to the best of
my knowledge.
Date:
Signature: ____________________________________
This application must be sent to the address below or faxed to 709-729-6969:
Pesticide Licensing Officer
Department of Municipal Affairs and Environment
Pesticides Control Section
P.O. Box 8700
St. John’s, NL
A1B 4J6
Government of Newfoundland and Labrador
Department of Municipal Affairs and Environment
Privacy Notice
Under the authority of the Environmental Protection Act SNL 2002 cE-14.2, personal
information will be collected for the purpose of enforcing the Pesticides Control Regulations
2012. This allows the Department of Municipal Affairs and Environment to disclose personal
information to other Federal and Provincial Departments and Agencies.
Annual Pesticide Summary
Company Name: _______________________________________________________
Pesticide Operator Licence #:_______________
Year ending December 31, ________
Name of company/companies from whom you purchased pesticides:
_______________________________________________
_______________________________________________
_______________________________________________
Pesticide Trade
Quantity
Quantity
PCP #
Classification
Name
Purchased
Used
I hereby certify that the information provided in this application is accurate, to the best of
my knowledge.
Date:
Signature: ____________________________________
This application must be sent to the address below or faxed to 709-729-6969:
Pesticide Licensing Officer
Department of Municipal Affairs and Environment
Pesticides Control Section
P.O. Box 8700
St. John’s, NL
A1B 4J6