"Application for License Recertification or New License Certification by Reciprocation With Another State - Commercial or Noncommercial Pesticide Applicator" - Utah

Application for License Recertification or New License Certification by Reciprocation With Another State - Commercial or Noncommercial Pesticide Applicator 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
Information in this box to
PESTICIDE PROGRAM
be completed by UDAF.
Temporary receipt or
350 N. Redwood Road
transaction number:
P.O. Box 146500
Amount paid:
Salt Lake City, UT 84114-6500
(801) 538-7185 Information
(801) 538-7189 FAX
http://ag.utah.gov
Application for License Recertification Or
New License Certification by Reciprocation with Another State
COMMERCIAL OR NONCOMMERCIAL PESTICIDE APPLICATOR
(4001-4002)
This application must be accompanied by payment of cash or check (Write check to UDAF).
The cost of a three year pesticide license is $65 for a commercial applicator or $20 for a noncommercial applicator.
Commercial companies must also purchase a Pesticide Business License ($75: 1 to 4 applicators, $150: 5 to 9 applicators,
$300 for 10 or more applicators).
If a credit card must be used, Visa, MasterCard, Discover, or American Express are acceptable.
*Private Pesticide Applicators should not complete this form *
**Do not complete this form if you are testing to re-certify, or certifying for the first time**
Please print the following information neatly. In Utah, 16 years is the minimum age for a license.
Commercial
Current License Number:
4001-
4002-
or check if new license
Noncommercial
Initial:
Last Name:
First Name:
Home Mailing Address:
City:
State:
Zip:
*** Email:
Daytime
Evening
Cellular
Phone #
Phone #
Phone #
Business/Employer Name:
A commercial license will not by mailed without a business address.
Business/Employer Address:
City:
State:
Zip:
This application is for a commercial or noncommercial pesticide applicator license (check all that apply):
Paper records for the Continuing Education Units (CEUs) completed must be presented at the time this application is submitted. Only the categories
currently existing on a valid license will appear on a new license unless additional category exams are completed. New categories may be added to a
renewed license by successfully completing the appropriate category examination when paying for re-certification. Categories added after recerti-
fication incur a $15.00 fee.
Recertification by earning 24 CEUs in the correct areas of Law, Use and Safety
The information in this box must be completed by a UDAF representative. A total of 24 CEUs are required for recertification without testing.
Pesticide Law CEUs (minimum of 2 hours)
Pesticide Safety CEUs (minimum of 6 hours)
Pesticide Use CEUs (minimum of 10 hours)
Reciprocal license agreement with another state
Name of State:
Indicate how many years (1, 2 or 3 years) the reciprocal license will be paid with this application
years
I attest that the above information is correct, that I will adhere to all state and federal pesticide laws, that I will follow all
appropriate pesticide label instructions and requirements, and that I am accountable for all pesticide application and handling
actions that I perform or supervise.
Date
Confirmed by UDAF Employee
Signature of Applicant for Pesticide License
Application must be accompanied by payment of cash or check (write check to UDAF).
If a credit card is used the applicator will not receive a receipt.
Reset Form
UTAH DEPARTMENT OF AGRICULTURE AND FOOD
Information in this box to
PESTICIDE PROGRAM
be completed by UDAF.
Temporary receipt or
350 N. Redwood Road
transaction number:
P.O. Box 146500
Amount paid:
Salt Lake City, UT 84114-6500
(801) 538-7185 Information
(801) 538-7189 FAX
http://ag.utah.gov
Application for License Recertification Or
New License Certification by Reciprocation with Another State
COMMERCIAL OR NONCOMMERCIAL PESTICIDE APPLICATOR
(4001-4002)
This application must be accompanied by payment of cash or check (Write check to UDAF).
The cost of a three year pesticide license is $65 for a commercial applicator or $20 for a noncommercial applicator.
Commercial companies must also purchase a Pesticide Business License ($75: 1 to 4 applicators, $150: 5 to 9 applicators,
$300 for 10 or more applicators).
If a credit card must be used, Visa, MasterCard, Discover, or American Express are acceptable.
*Private Pesticide Applicators should not complete this form *
**Do not complete this form if you are testing to re-certify, or certifying for the first time**
Please print the following information neatly. In Utah, 16 years is the minimum age for a license.
Commercial
Current License Number:
4001-
4002-
or check if new license
Noncommercial
Initial:
Last Name:
First Name:
Home Mailing Address:
City:
State:
Zip:
*** Email:
Daytime
Evening
Cellular
Phone #
Phone #
Phone #
Business/Employer Name:
A commercial license will not by mailed without a business address.
Business/Employer Address:
City:
State:
Zip:
This application is for a commercial or noncommercial pesticide applicator license (check all that apply):
Paper records for the Continuing Education Units (CEUs) completed must be presented at the time this application is submitted. Only the categories
currently existing on a valid license will appear on a new license unless additional category exams are completed. New categories may be added to a
renewed license by successfully completing the appropriate category examination when paying for re-certification. Categories added after recerti-
fication incur a $15.00 fee.
Recertification by earning 24 CEUs in the correct areas of Law, Use and Safety
The information in this box must be completed by a UDAF representative. A total of 24 CEUs are required for recertification without testing.
Pesticide Law CEUs (minimum of 2 hours)
Pesticide Safety CEUs (minimum of 6 hours)
Pesticide Use CEUs (minimum of 10 hours)
Reciprocal license agreement with another state
Name of State:
Indicate how many years (1, 2 or 3 years) the reciprocal license will be paid with this application
years
I attest that the above information is correct, that I will adhere to all state and federal pesticide laws, that I will follow all
appropriate pesticide label instructions and requirements, and that I am accountable for all pesticide application and handling
actions that I perform or supervise.
Date
Confirmed by UDAF Employee
Signature of Applicant for Pesticide License
Application must be accompanied by payment of cash or check (write check to UDAF).
If a credit card is used the applicator will not receive a receipt.
Reset Form
This is the back page of the application for a commercial or noncommercial pesticide applicator license.
he criteria for commercial, noncommercial, and private pesticide applicators are as follows:
T
Commercial Applicator - any person who uses any pesticide for hire or compensation.
Noncommercial Applicator - any person working as an individual or an employee of a firm, entity or government agency who uses or demonstrates the use of any
restricted use pesticide and who does not qualify as a private applicator, nor require a commercial applicator's license.
Private Applicator - any person or his/her employer who uses or supervises the use of any restricted use pesticide for the purpose of producing any agricultural
commodity on property owned or rented by an individual or that individual’s employer or (if applied without compensation other than trading of services between
producers of agricultural commodities) on the property of another person.
The license categories for commercial, noncommercial and private pesticide applicators are as follows:
(1) Agricultural Pest Control.
(a) Plant. This category includes applicators using pesticides to control pests in the production of agricultural crops including, but not limited to, field crops,
vegetables, fruits, pasture, rangelands, and non-crop agricultural lands.
(b) Animal. This category includes applicators using pesticides on animals including, but not limited to, beef and dairy cattle, swine, sheep, horses, goats,
poultry, and to places on or in which animals inhabit. Doctors of veterinary medicine or their employees engaged in the business of applying pesticides for
hire, publicly representing themselves as pesticide applicators or engaged in large-scale use of pesticides, are included in this category.
(2) Forest Pest Control. This category includes applicators using pesticides in forests, forest nurseries, and forest seed-producing areas.
(3) Ornamental and Turf Pest Control. This category includes applicators using pesticides to control pests in the maintenance and production of ornamental trees,
shrubs, flowers and turf. This includes controlling pests around home foundations, sidewalks, driveways, and other similar locations.
(4) Seed Treatment. This category includes applicators using pesticides on seeds.
(5) Aquatic Pest Control.
(a) Surface Water: This category includes applicators applying pesticides to standing or running water, excluding applicators engaged in public health related
activities included in R68-7-6(8).
(b) Sewer Root Control: This category includes applicators using pesticides to control roots in sewers or in related systems.
(6) Right-of-Way Pest Control. This category includes applicators using pesticides in the maintenance of public roads, electric power lines, pipelines, railway rights-of-way,
or other similar areas.
(7) Structural and Health-related Pest Control. This category excludes any fumigation pesticide application and is limited to applicators using pesticides in, on, or around
food handling establishments; human dwellings; institutions, such as schools and hospitals; industrial establishments, including warehouses, storage units and any
other structures and adjacent areas, public or private; to control household pests, fabric pests, and stored-product pests and to protect stored, processed and
manufactured products. This category includes vertebrate pest control in and around buildings.
(8) Public Health Pest Control. This category includes applicators applying the use of pesticides in public- health programs for the management and control of pests
having medical and public-health importance.
(9) Regulatory Pest Control.
(a) This category is limited to state and federal, employees or persons under their direct supervision, who apply pesticides in a mechanical ejection device, or
other methods to control regulated pests.
(b) This category is limited to state and federal, employees or persons under their direct supervision, who apply pesticides in a protective collar, or other
methods to control regulated pests.
(10) Demonstration, Consultation and Research Pest Control. This category includes individuals who demonstrate or provide instruction to the public in the proper use,
techniques, benefits and methods of applying restricted-use pesticides. This category includes, but is not limited to agricultural compliance specialists, extension
personnel, commercial representatives, consultants and advisors, and persons conducting field research with restricted-use pesticides. In addition, they shall meet the
specific standards that may be applicable to their particular activity.
(11) Aerial Application Pest Control. This category includes applicators applying pesticides by aircraft. Aerial applicators are required to be certified in the Aerial
Application Pest Control Category and any other categories of intended application.
(12) Vertebrate Animal Pest Control. This category includes applicators applying pesticides in the control of vertebrate pests outdoors, such as rodents, birds, bats,
predators or domestic animals.
(13) Fumigation/Stored Commodities Pest Control. This category includes applicators using fumigants to control pests in soils, structures, railroad cars, stored grains,
manufactured products, grain elevators, flour mills, and similar areas and items.
(14) Wood-Preservation Pest Control. This category includes applicators who apply wood-preservative pesticides to wood products, such as fence posts, electrical poles,
railroad ties, or any other form of wood products.
(15) Wood-Destroying Organisms Pest Control. This category includes applicators using pesticides to control termites, carpenter ants, wood-boring or tunneling insects,
bees, wasps, wood-decaying fungi and any other pests destroying wood products, grain elevators, flour mills, and similar areas and items.
Addresses and Contact Information for Utah Pesticide License Testing Centers:
Duchesne
USU Extension
Box Elder County
USU Extension
100 S 50 E
Contact: Julie Abbott
1 S Main St.
Contact: Donna Tracy
Duchesne, Utah 84021
(435) 738-1141
Brigham City, Utah 84302
(435) 695-2542
Roosevelt
Cache County Courthouse
510 W 200 N (59-15)
Contact: Bob Puck
179 N Main St. Ste 111F
Contact: Mark Ashcroft
Roosevelt, Utah 84066
(435) 725-0202
Logan, Utah 84321
(435) 752-6263
Vernal USU Extension
Ogden Grain Lab
152 E Main St. 3rd Floor
Contact: Mary Lou Burton
128 17th St.
Contact: Dave Daniels
Vernal, Utah 84078
(435) 781-5452
Ogden, Utah 84401
(801) 580-3653
Utah Dept of Agriculture and Food
Carbon County Courthouse
350 N Redwood Rd.
Contact: Shelly Jensen
120 E Main St.
Contact: Dave Basinger
Price, Utah 84501
(435) 636-3234
Salt Lake City, Utah 84114
(801) 538-7185
Moab
Utah County Health & Justice Bldg
USU Extension
125 W 200 S
Contact: Mike Johnson
151 S University Ave. Ste 3100
Contact: Darrell Cook
Provo, Utah 84601
(801) 851-7792
Moab, Utah 84532
(435) 259-7558
Arrangements for Counties
Monticello
USU Extension
Garfield, Millard, Piute
Contact: Roger Brian
117 S Main St.
Contact: Jim Keyes
Monticello, Utah 84535
(435) 587-3239
Sevier, Sanpete, Wayne
(435) 979-5075
Washington County Admin Bldg
197 E Tabernacle St.
Contact: Amy Davidson
Saint George, Utah 84770
(435) 986-3391
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