"Dealer License Application for Restricted Use Pesticides (4004)" - Utah

Dealer License Application for Restricted Use Pesticides (4004) is a legal document that was released by the Utah Department of Agriculture and Food - a government authority operating within Utah.

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UTAH DEPARTMENT OF AGRICULTURE AND FOOD
350 N. Redwood Road
P.O. Box 146500
Salt Lake City, UT 84114-6500
(801) 538-7185 Information
(801) 538-7189 FAX
UDAF-Pesticide@utah.gov
DEALER LICENSE APPLICATION FOR
RESTRICTED USE PESTICIDES (4004)
$100.00/3 years
Regulations established under the Utah Pesticide Control Act (R68-7-9) provide that any person acting in the
capacity of a Restricted Use Pesticide Dealer must be licensed by the Utah Department of Agriculture and
Food. A three-year license shall be issued upon payment by the applicant of a fee of one hundred dollars
($100.00). The license shall expire on December 31 of the third year of its issuance and can be renewed by
payment of the fee prior to January 1 of each three-year period thereafter.
Checks are to be made payable to: Utah Department of Agriculture and Food
PO Box 146500
Salt Lake City, UT 84114-6500
I hereby apply for a license to sell restricted use pesticides in the State of Utah in compliance with the Utah Pesticide
Control Act and regulations promulgated thereunder.
License No. (if renewing)
Business Name
Location Address
Mailing Address
Cell Phone
Phone
FAX
Email
Name of Owner or Manager
Signature of Owner or Manager
Date
Reset Form
UTAH DEPARTMENT OF AGRICULTURE AND FOOD
350 N. Redwood Road
P.O. Box 146500
Salt Lake City, UT 84114-6500
(801) 538-7185 Information
(801) 538-7189 FAX
UDAF-Pesticide@utah.gov
DEALER LICENSE APPLICATION FOR
RESTRICTED USE PESTICIDES (4004)
$100.00/3 years
Regulations established under the Utah Pesticide Control Act (R68-7-9) provide that any person acting in the
capacity of a Restricted Use Pesticide Dealer must be licensed by the Utah Department of Agriculture and
Food. A three-year license shall be issued upon payment by the applicant of a fee of one hundred dollars
($100.00). The license shall expire on December 31 of the third year of its issuance and can be renewed by
payment of the fee prior to January 1 of each three-year period thereafter.
Checks are to be made payable to: Utah Department of Agriculture and Food
PO Box 146500
Salt Lake City, UT 84114-6500
I hereby apply for a license to sell restricted use pesticides in the State of Utah in compliance with the Utah Pesticide
Control Act and regulations promulgated thereunder.
License No. (if renewing)
Business Name
Location Address
Mailing Address
Cell Phone
Phone
FAX
Email
Name of Owner or Manager
Signature of Owner or Manager
Date
Reset Form