Instructions for Form AG-0568 "Pesticide Investigation Request Form" - Tennessee

This document contains official instructions for Form AG-0568, Pesticide Investigation Request Form - a form released and collected by the Tennessee Department of Agriculture. An up-to-date fillable Form AG-0568 is available for download through this link.

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Download Instructions for Form AG-0568 "Pesticide Investigation Request Form" - Tennessee

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Tennessee Department of Agriculture
Regulatory Services Division, Pesticide Section
Pesticide Investigation Request Form
Information:
The Tennessee Department of Agriculture is responsible for the enforcement of State and Federal pesticide
laws and regulations. By completing the attached form you are providing information needed to investigate the
manufacture, sale and/or use application of a pesticide. Submitting this form will authorize the Department to
inspect your property if needed, examine and copy any pertinent documents, collect written statements, and
take samples if necessary.
The Department is authorized to investigate those cases involving alleged pesticide mis-use, pesticide drift,
substandard termite treatments if there is a current contract, failure to issue a termite contract, failure to retreat
active termite infestations, certain sales practices leading to the application of a pesticide, pesticide mis-
labeling, illegal pesticide applicators, illegal pesticide sales, and illegal pesticide manufacture. The Department
regulates Wood Destroying Insect Infestation Inspection Reports known as clearance letters from the
perspective of those qualified to issue the reports, conducting inspections, contents of the report, and the
penalty for those not qualified to issue these reports.
The Department does not have authority regarding pricing of pesticides and/or pesticide application services,
contractual disputes over payment, non-pesticide services, and personal or property damage disputes. These
issues are usually of a civil nature. You may find assistance through the Tennessee Division of Consumer
Affairs at 1-800-342-8385 or your local Better Business Bureau.
For questions concerning pesticides you may contact your health care provider. You may also find health and
pesticide safety information by contacting the EPA National Pesticide Info Center at 1-800-858-7378.
Instructions:
The Tennessee Department of Agriculture requires that all Pesticide Investigation Requests be submitted in
written form. Please complete the attached form providing as much information as possible and attach copies
of all pertinent documents such as contracts, service tickets, canceled checks (front and back), letters,
diagrams or photographs. Incomplete forms and documentation not included will delay the processing
of your complaint.
Return your completed form to the address listed below.
Tennessee Department of Agriculture, Regulatory Services Division, Pesticide Section, P.O. Box 40627,
Melrose Station, Nashville, TN 37204, Phone: 615-837-5148, Outside the local calling area: 1-800-628-2631:
Fax: 615-837-5012
Upon receipt of the Pesticide Investigation Request Form, an inspector in your area will contact you and
discuss your request prior to beginning any investigation. Responses will be prioritized based on the nature of
the request.
Tennessee Department of Agriculture
Regulatory Services Division, Pesticide Section
Pesticide Investigation Request Form
Information:
The Tennessee Department of Agriculture is responsible for the enforcement of State and Federal pesticide
laws and regulations. By completing the attached form you are providing information needed to investigate the
manufacture, sale and/or use application of a pesticide. Submitting this form will authorize the Department to
inspect your property if needed, examine and copy any pertinent documents, collect written statements, and
take samples if necessary.
The Department is authorized to investigate those cases involving alleged pesticide mis-use, pesticide drift,
substandard termite treatments if there is a current contract, failure to issue a termite contract, failure to retreat
active termite infestations, certain sales practices leading to the application of a pesticide, pesticide mis-
labeling, illegal pesticide applicators, illegal pesticide sales, and illegal pesticide manufacture. The Department
regulates Wood Destroying Insect Infestation Inspection Reports known as clearance letters from the
perspective of those qualified to issue the reports, conducting inspections, contents of the report, and the
penalty for those not qualified to issue these reports.
The Department does not have authority regarding pricing of pesticides and/or pesticide application services,
contractual disputes over payment, non-pesticide services, and personal or property damage disputes. These
issues are usually of a civil nature. You may find assistance through the Tennessee Division of Consumer
Affairs at 1-800-342-8385 or your local Better Business Bureau.
For questions concerning pesticides you may contact your health care provider. You may also find health and
pesticide safety information by contacting the EPA National Pesticide Info Center at 1-800-858-7378.
Instructions:
The Tennessee Department of Agriculture requires that all Pesticide Investigation Requests be submitted in
written form. Please complete the attached form providing as much information as possible and attach copies
of all pertinent documents such as contracts, service tickets, canceled checks (front and back), letters,
diagrams or photographs. Incomplete forms and documentation not included will delay the processing
of your complaint.
Return your completed form to the address listed below.
Tennessee Department of Agriculture, Regulatory Services Division, Pesticide Section, P.O. Box 40627,
Melrose Station, Nashville, TN 37204, Phone: 615-837-5148, Outside the local calling area: 1-800-628-2631:
Fax: 615-837-5012
Upon receipt of the Pesticide Investigation Request Form, an inspector in your area will contact you and
discuss your request prior to beginning any investigation. Responses will be prioritized based on the nature of
the request.