Form FDACS-08208 "Application and Permit to Move Organisms Regulated by the State of Florida" - Florida

What Is Form FDACS-08208?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2013;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FDACS-08208 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Florida Department of Agriculture and Consumer Services
Division of Plant Industry
Remit o nline paymen t at
www.FDACS.gov
APPLICATION AND PERMIT TO MOVE ORGANISMS
Or
REGULATED BY THE STATE OF FLORIDA
Check or Money order payable
to:
NICOLE "NIKKI" FRIED
Section 581.083, 581.211, F.S./Incorporated in Rule 5B-57.004, F.A.C.
FDACS
COMMISSIONER
Referenced in Rule 5B-2.010, F.A.C.
P.O. Box 6720
th
Tallahassee, FL 32314-6720
1911 S.W. 34
Street/PO Box 147100, Gainesville, Florida 32614-7100
Phone: (352)395-4700
Fax: (352)395-4614
Page ____ of ____
THIS SECTION TO BE COMPLETED BY STATE OFFICIAL
Approved
Disapproved
Permit Number
Conditions
*If disapproved, see Notice of Administrative Hearing on Page 8.
Signature
Valid Until
Title
Date
THIS SECTION TO BE COMPLETED BY APPLICANT
1. Renewal of Permit? 2.
Name:
Title:
Yes
No
Business Name:
If yes, indicate
Physical Address:
permit number
City, State Zip Code:
3. Mailing Address:
City, State Zip Code:
4. Telephone No.
5. Fax No.
6. Email Address
7. I/We agree to comply with the stipulations of this agreement, and understand that a permit may be subject to other conditions specified.
Signature of Applicant
Date
8. Type of Organisms to be Moved
Arthropods
Plant Pathogens
Nematodes
Noxious Weeds
Genetically Altered Organisms
Biological Control Agents
Other (Specify):
Scientific Names of Organisms
Classification
Life
Number of
Shipped From
In U.S.
Host Material
Approved
)
to be Moved
(Order, Family, Other)
Stages
Specimens
Yes/No
Included
(
9.
10.
11.
In addition to the above listed organisms, additional organisms to be moved are listed starting at Line # 34
12.
Number of Shipments
13.
Port of Arrival
14.
Approximate Date of Arrival or Interstate Movement
15.
Destination/Location of Movement
16.
Method of Shipment
Air
Air Freight
Auto
Baggage
17.
Other
(Specify)
18.
Supplier No. 01 - Name & Address
19.
Supplier No. 02 - Name & Address
20.
Supplier No. 03 - Name & Address
21.
General Purpose of Request
(Be specific)
22.
Intended Use
(Be specific)
23.
Methods to be Used to Prevent Organisms Escape
(Be specific)
Standards and Safe Guards of Permit: 1). All organisms must be shipped in sturdy, escape-proof containers. 2). Upon receipt, all packaging material and shipping containers shall be sterilized or
destroyed immediately after removing organisms. 3). Organisms shall be kept only within the laboratory at the permittee’s address. 4). No living organisms kept under this permit shall be removed from
confined area except by prior approval from this office. 5). Without prior notice and during reasonable hours, authorized State Regulatory Officials shall be allowed to inspect the conditions under which
the organisms are kept. 6). All organisms kept under this permit shall be destroyed at the completion of the intended use, and not later than the expiration date. 7). All necessary precautions must be taken
to prevent escape. In the event of an escape, notify this office.
Under authority of Chapter 581.083, Florida Statues (FS), and Rule Chapter 5B-57, Florida Administrative Code (FAC), permission is hereby granted to the applicant named above to move the organisms
described, except as deleted, subject to the conditions stated on, or attached to, this application. This permit not valid unless signed by an official authorized representative of the department. Failure to
comply with stipulations of this agreement may result in penalties as stipulated in Rule 5B-57.0010, FAC, and Section 581.211, FS. If disapproved, see Notice of Administrative Hearing on Page 8.
FDACS-08208 Rev. 01/13
Page 1 of 8
Florida Department of Agriculture and Consumer Services
Division of Plant Industry
Remit o nline paymen t at
www.FDACS.gov
APPLICATION AND PERMIT TO MOVE ORGANISMS
Or
REGULATED BY THE STATE OF FLORIDA
Check or Money order payable
to:
NICOLE "NIKKI" FRIED
Section 581.083, 581.211, F.S./Incorporated in Rule 5B-57.004, F.A.C.
FDACS
COMMISSIONER
Referenced in Rule 5B-2.010, F.A.C.
P.O. Box 6720
th
Tallahassee, FL 32314-6720
1911 S.W. 34
Street/PO Box 147100, Gainesville, Florida 32614-7100
Phone: (352)395-4700
Fax: (352)395-4614
Page ____ of ____
THIS SECTION TO BE COMPLETED BY STATE OFFICIAL
Approved
Disapproved
Permit Number
Conditions
*If disapproved, see Notice of Administrative Hearing on Page 8.
Signature
Valid Until
Title
Date
THIS SECTION TO BE COMPLETED BY APPLICANT
1. Renewal of Permit? 2.
Name:
Title:
Yes
No
Business Name:
If yes, indicate
Physical Address:
permit number
City, State Zip Code:
3. Mailing Address:
City, State Zip Code:
4. Telephone No.
5. Fax No.
6. Email Address
7. I/We agree to comply with the stipulations of this agreement, and understand that a permit may be subject to other conditions specified.
Signature of Applicant
Date
8. Type of Organisms to be Moved
Arthropods
Plant Pathogens
Nematodes
Noxious Weeds
Genetically Altered Organisms
Biological Control Agents
Other (Specify):
Scientific Names of Organisms
Classification
Life
Number of
Shipped From
In U.S.
Host Material
Approved
)
to be Moved
(Order, Family, Other)
Stages
Specimens
Yes/No
Included
(
9.
10.
11.
In addition to the above listed organisms, additional organisms to be moved are listed starting at Line # 34
12.
Number of Shipments
13.
Port of Arrival
14.
Approximate Date of Arrival or Interstate Movement
15.
Destination/Location of Movement
16.
Method of Shipment
Air
Air Freight
Auto
Baggage
17.
Other
(Specify)
18.
Supplier No. 01 - Name & Address
19.
Supplier No. 02 - Name & Address
20.
Supplier No. 03 - Name & Address
21.
General Purpose of Request
(Be specific)
22.
Intended Use
(Be specific)
23.
Methods to be Used to Prevent Organisms Escape
(Be specific)
Standards and Safe Guards of Permit: 1). All organisms must be shipped in sturdy, escape-proof containers. 2). Upon receipt, all packaging material and shipping containers shall be sterilized or
destroyed immediately after removing organisms. 3). Organisms shall be kept only within the laboratory at the permittee’s address. 4). No living organisms kept under this permit shall be removed from
confined area except by prior approval from this office. 5). Without prior notice and during reasonable hours, authorized State Regulatory Officials shall be allowed to inspect the conditions under which
the organisms are kept. 6). All organisms kept under this permit shall be destroyed at the completion of the intended use, and not later than the expiration date. 7). All necessary precautions must be taken
to prevent escape. In the event of an escape, notify this office.
Under authority of Chapter 581.083, Florida Statues (FS), and Rule Chapter 5B-57, Florida Administrative Code (FAC), permission is hereby granted to the applicant named above to move the organisms
described, except as deleted, subject to the conditions stated on, or attached to, this application. This permit not valid unless signed by an official authorized representative of the department. Failure to
comply with stipulations of this agreement may result in penalties as stipulated in Rule 5B-57.0010, FAC, and Section 581.211, FS. If disapproved, see Notice of Administrative Hearing on Page 8.
FDACS-08208 Rev. 01/13
Page 1 of 8
Florida Department of Agriculture and Consumer Services
Division of Plant Industry
APPLICATION AND PERMIT TO MOVE ORGANISMS
REGULATED BY THE STATE OF FLORIDA
Page ____ of ____
Permit Number ____________________
24.
Method of Final Disposition of Organisms and Host Material
(Accompanying materials and containers? (Be specific))
Plant Pathogens or Nematodes – Indicate Why Indigenous Pathogens or Nematodes. If Present and/or Available. Would Not Serve
25.
the Purposes of the Investigation
Plant Pathogens or Nematodes – What Are the Benefits of the Introduction?
26.
Plant Pathogens or Nematodes – What Are the Risks of the Introduction?
27.
Plant Pathogens or Nematodes – Please Provide Pertinent Literature References or Reprints
28.
29.
List all personnel who will be involved with the project at this location. The individual listed on page 1, in item number 2
is responsible for the individual(s) listed below to be in compliance with this permit
Project Assistant No. 01
Project Assistant No. 02
Project Assistant No. 03
Project Assistant No. 04
Project Assistant No. 05
Project Assistant No. 06
Project Assistant No. 07
Project Assistant No. 08
30.
Indicate Location of Work, and Briefly Describe the Test Facility and Methodology to be Used
31.
Indicate Sanitation Procedures to be Used to Contain Pathogen in the Test Area, and Security Measures to Prohibit Unauthorized
Access to Pathogen to Test Site
32.
Time Required for Completion of Project
33.
Will the organism be retained?
Yes
No
If Yes, Where and Why?
Additional Organisms To Be Moved Continued From Line # 11
Scientific Names of Organisms
Classification
Number of
In U.S.
Host Material
Approved
Life Stages
Shipped From
to be Moved
(Order, Family, Other)
Specimens
Yes / No
Included
()
34.
35.
36.
37.
38.
39.
40.
41.
Standards and Safe Guards of Permit: 1). All organisms must be shipped in sturdy, escape-proof containers. 2). Upon receipt, all packaging material and shipping containers shall be sterilized or destroyed immediately
after removing organisms. 3). Organisms shall be kept only within the laboratory at the permittee’s address. 4). No living organisms kept under this permit shall be removed from confined area except by prior approval
from this office. 5). Without prior notice and during reasonable hours, authorized State Regulatory Officials shall be allowed to inspect the conditions under which the organisms are kept. 6). All organisms kept under
this permit shall be destroyed at the completion of the intended use, and not later than the expiration date. 7). All necessary precautions must be taken to prevent escape. In the event of an escape, notify this office.
Under authority of Chapter 581.083, Florida Statues (FS), and Rule Chapter 5B-57, Florida Administrative Code (FAC), permission is hereby granted to the applicant named above to move the organisms described,
except as deleted, subject to the conditions stated on, or attached to, this application. This permit not valid unless signed by an official authorized representative of the department. Failure to comply with stipulations
If disapproved, see Notice of Administrative Hearing on Page 8.
of this agreement may result in penalties as stipulated in Rule 5B-57.0010, FAC, and Section 581.211, FS.
FDACS-08208 Rev. 01/13
Page 2 of 8
Florida Department of Agriculture and Consumer Services
Division of Plant Industry
APPLICATION AND PERMIT TO MOVE ORGANISMS
REGULATED BY THE STATE OF FLORIDA
Page ____ of ____
Permit Number ____________________
Scientific Names of Organisms
Classification
Number of
In U.S.
Host Material
Approved
Life Stages
Shipped From
to be Moved
(Order, Family, Other)
Specimens
Yes / No
Included
()
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
Standards and Safe Guards of Permit: 1). All organisms must be shipped in sturdy, escape-proof containers. 2). Upon receipt, all packaging material and shipping containers shall be sterilized or destroyed immediately
after removing organisms. 3). Organisms shall be kept only within the laboratory at the permittee’s address. 4). No living organisms kept under this permit shall be removed from confined area except by prior approval
from this office. 5). Without prior notice and during reasonable hours, authorized State Regulatory Officials shall be allowed to inspect the conditions under which the organisms are kept. 6). All organisms kept under
this permit shall be destroyed at the completion of the intended use, and not later than the expiration date. 7). All necessary precautions must be taken to prevent escape. In the event of an escape, notify this office.
Under authority of Chapter 581.083, Florida Statues (FS), and Rule Chapter 5B-57, Florida Administrative Code (FAC), permission is hereby granted to the applicant named above to move the organisms described,
except as deleted, subject to the conditions stated on, or attached to, this application. This permit not valid unless signed by an official authorized representative of the department. Failure to comply with stipulations
If disapproved, see Notice of Administrative Hearing on Page 8.
of this agreement may result in penalties as stipulated in Rule 5B-57.0010, FAC, and Section 581.211, FS.
FDACS-08208 Rev. 01/13
Page 3 of 8
Florida Department of Agriculture and Consumer Services
Division of Plant Industry
APPLICATION AND PERMIT TO MOVE ORGANISMS
REGULATED BY THE STATE OF FLORIDA
Page ____ of ____
Permit Number ____________________
Scientific Names of Organisms
Classification
Number of
In U.S.
Host Material
Approved
Life Stages
Shipped From
to be Moved
(Order, Family, Other)
Specimens
Yes / No
Included
()
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
Standards and Safe Guards of Permit: 1). All organisms must be shipped in sturdy, escape-proof containers. 2). Upon receipt, all packaging material and shipping containers shall be sterilized or destroyed immediately
after removing organisms. 3). Organisms shall be kept only within the laboratory at the permittee’s address. 4). No living organisms kept under this permit shall be removed from confined area except by prior approval
from this office. 5). Without prior notice and during reasonable hours, authorized State Regulatory Officials shall be allowed to inspect the conditions under which the organisms are kept. 6). All organisms kept under
this permit shall be destroyed at the completion of the intended use, and not later than the expiration date. 7). All necessary precautions must be taken to prevent escape. In the event of an escape, notify this office.
Under authority of Chapter 581.083, Florida Statues (FS), and Rule Chapter 5B-57, Florida Administrative Code (FAC), permission is hereby granted to the applicant named above to move the organisms described,
except as deleted, subject to the conditions stated on, or attached to, this application. This permit not valid unless signed by an official authorized representative of the department. Failure to comply with stipulations
If disapproved, see Notice of Administrative Hearing on Page 8.
of this agreement may result in penalties as stipulated in Rule 5B-57.0010, FAC, and Section 581.211, FS.
FDACS-08208 Rev. 01/13
Page 4 of 8
Florida Department of Agriculture and Consumer Services
Division of Plant Industry
APPLICATION AND PERMIT TO MOVE ORGANISMS
REGULATED BY THE STATE OF FLORIDA
Page ____ of ____
Permit Number ____________________
Scientific Names of Organisms
Classification
Number of
In U.S.
Host Material
Approved
Life Stages
Shipped From
to be Moved
(Order, Family, Other)
Specimens
Yes / No
Included
()
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
128
Standards and Safe Guards of Permit: 1). All organisms must be shipped in sturdy, escape-proof containers. 2). Upon receipt, all packaging material and shipping containers shall be sterilized or destroyed immediately
after removing organisms. 3). Organisms shall be kept only within the laboratory at the permittee’s address. 4). No living organisms kept under this permit shall be removed from confined area except by prior approval
from this office. 5). Without prior notice and during reasonable hours, authorized State Regulatory Officials shall be allowed to inspect the conditions under which the organisms are kept. 6). All organisms kept under
this permit shall be destroyed at the completion of the intended use, and not later than the expiration date. 7). All necessary precautions must be taken to prevent escape. In the event of an escape, notify this office.
Under authority of Chapter 581.083, Florida Statues (FS), and Rule Chapter 5B-57, Florida Administrative Code (FAC), permission is hereby granted to the applicant named above to move the organisms described,
except as deleted, subject to the conditions stated on, or attached to, this application. This permit not valid unless signed by an official authorized representative of the department. Failure to comply with stipulations
If disapproved, see Notice of Administrative Hearing on Page 8.
of this agreement may result in penalties as stipulated in Rule 5B-57.0010, FAC, and Section 581.211, FS.
FDACS-08208 Rev. 01/13
Page 5 of 8