2012 Pesticide Establishment Registration Form...2012 Pesticide Establishment Registration Form...
Transcript of 2012 Pesticide Establishment Registration Form...2012 Pesticide Establishment Registration Form...
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United States
ENVIRONMENTAL PROTECTION AGENCY
Washington, DC 20460
Application for Registration of Pesticide-Producing and Device-Producing Establishment
Office of Enforcement and Compliance Assurance
Section 7, Federal Insecticide, Fungicide and Rodenticide Act (7 U.S.C. sec. 136e)
http://www2.epa.gov/compliance/pesticide-establishment-registration-and-reporting
OMB Control No. 2070-0078
Expires on 3/31/2016
EPA Form 3540-8 (Rev. 1/15) Previous versions are obsolete.
Page of
For EPA Use Only
Reviewer
EPA Region
Review Date
Postmark Date
Company Information
Authorized Agent (if applicable)
Signature of Company Official or Authorized Agent
Name and Site Address of Each Producing Establishment You are Registering
EPA Est. No.
(For EPA Use Only)
EPA/OECA/OC/MAMAPD
2012 Pesticide Establishment Registration Form
Form to register pesticide-producing establishments with EPA
2015
getinstructions: CurrentPage: PageCount: Press enter to add an additional page to enter additional establishments: Press enter to remove extra pages : print: ResetButton1: CoName: CoNumber: DBA: co.site.address: co.site.city: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: CoSiteProvince: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: CoSiteZipcode: CoMai.Address: CoMai.City: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: CoMailProvince: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: CoMailzipcode: phone: email: agent: AgentName: AgentAddress: AgentCity: AgentState: AgentZip: AgentPhone: AgenteMail: OffName: OffTitle: OffSign: Date: estabname2: EstabSiteAdd: Estab.site.city: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: EstabSiteProvince: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: EstabSiteZipcode: Estab.Mail.Address: EstabMailCity: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: EstabMailProvince: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: EstabMailZipcode: EstabPhone: EstabMailemail: