The Arkansas DP-42 form is an official application used to request permission for the delivery and dispensing of bulk pesticides at a dealer's facility. This form must be completed and submitted to the Arkansas State Plant Board, ensuring compliance with state regulations regarding pesticide handling. To begin the process, fill out the form by clicking the button below.
The Arkansas DP-42 form is a crucial document designed for those involved in the delivery and dispensing of bulk pesticides within the state. This application serves as a request for permission from the Arkansas State Plant Board, allowing dealers to receive bulk pesticides at their facilities and to dispense them to licensed applicators. The form requires detailed information, including the dealer's name, contact details, and the manufacturer's information. Additionally, it outlines specific conditions that must be met to ensure compliance with state regulations. For instance, all pesticides must be registered, containers must be clearly labeled, and adequate safety measures must be in place to prevent contamination and protect individuals and the environment. The form also emphasizes the need for proper handling and storage, ensuring that all metering devices are approved and that containers are cleaned and relabeled before being used for different pesticides. Understanding the requirements and responsibilities outlined in the DP-42 form is essential for dealers and manufacturers alike, as it helps maintain safety standards and regulatory compliance in the pesticide industry.
Form DP-42
ARKANSAS STATE PLANT BOARD
(Rev 09/08)
DIVISION OF PESTICIDES
P. O. BOX 1069, LITTLE ROCK, ARKANSAS 72203
APPLICATION FOR PERMISSION TO DELIVER BULK PESTICIDES
TO A DEALER’S FACILITY AND PERMISSION FOR THE DEALER
TO DISPENSE BULK PESTICIDES
IN STR UC TIO N S:
Complete and submit to the Arkansas State Plant Board. A signed copy will be returned upon approval to each
location.
EPA ESTABLISHMENT NUMBER. _______________________________
________________________________________________________________________________________
Dealer’s Name
____________________________________________________________(______)_____________________
Complete Mailing AddressTelephone Number
CityStateZip Code
Manufacturer’s or Registrant’s Name
_____________________________________________________________(______)____________________
________________________________________________________________________________________.
City
State
Zip Code
The above manufacturer requests permission to deliver bulk pesticides and the above dealer request permission to install facilities for dispensing the pesticide to Arkansas licensed applicators at certain locations, as are hereinafter designated, subject to the following conditions:
1.All products will be registered with the State Plant Board by the manufacturer.
2.All containers to be dispensed from will be plainly marked by the dealer with paint or stenciling in large letters showing the name and address of the dealer applicant, and a phrase similar to “Warning --
Contains Pesticides.”
3.All containers will bear a complete label, as registered, for the product therein, including the manufacturer’s name and address as provided by the manufacturer.
4.All containers must contain suitable sample points to permit sampling by personnel of the State Plant Board. Samples must be accepted without reservation as being representative of the material therein and described on the label attached.
5.All containers are charged or recharged, the filling inlet will be sealed by the dealer in such a manner as to prevent tampering with the contents.
6.The dealer must meet EPA established guidelines for handling bulk pesticides and in accordance with all Department of Transportation (DOT) regulations.
7.The dealer must make adequate provision for handling to prevent contamination or injury to persons, livestock, and crops.
8.The dealer and person in charge as indicated herein will be responsible for overall operation of the location.
DP-42 page 2
9.In those cases in which the dealer is not the manufacturer’s agent, the manufacturer shall designate a resident agent for service of process.
10.Containers, prior to being used for a different pesticide, will be thoroughly cleaned by the dealer and relabeled.
11.All metering devices will be subject to approval of the Weights and Measures Division of the Plant Board.
BULK HANDLING LOCATION -- The location, product(s), the applicator(s) to be serviced by the dealer, manufacturer’s resident agent, and the person in charge of the dealer’s operation will be as follows:
Location (be specific)
Products (List complete brand name.)
Container 1 ______________________________________ Size _______ Gals. EPA Reg. No. ____________
Container 2 ______________________________________ Size _______ Gals. EPA Reg. No. ____________
Container 3 ______________________________________ Size _______ Gals. EPA Reg. No. ____________
Applicator (s)
__________________________________________________________________________________________
Manufacturer’s Resident Agent ________________________________________________________________
Address
Dealer ____________________________________________________________________________________
Person in Charge ___________________________________________________________________________
Address ________________________________________________Phone No. ________________________
NOTE: If changes are desired after approval, an amendment to this application must be filed.
DO NOT WRITE IN THIS SPACE
APPROVED FOR 20 ______
_________________________________
PESTICIDE DIVISION
_______________________________
DATE
PERMIT NUMBER
Dealer______________________________________
Title _______________________________________
Date _______________________________________
Signature ___________________________________
Manufacturer ________________________________
Signature____________________________________
Completing the Arkansas DP-42 form involves several steps to ensure that all necessary information is accurately provided. Once the form is filled out and submitted to the Arkansas State Plant Board, a signed copy will be returned upon approval. This process is essential for compliance with state regulations regarding the delivery and dispensing of bulk pesticides.
The Arkansas DP-42 form is an application used to obtain permission for the delivery and dispensing of bulk pesticides at a dealer's facility. This form is essential for ensuring that both the manufacturer and dealer comply with state regulations regarding pesticide handling. By submitting this form, dealers can legally receive and dispense pesticides to licensed applicators in Arkansas, thereby facilitating safe agricultural practices.
Both the manufacturer of the pesticides and the dealer who will dispense them are required to complete the DP-42 form. The manufacturer must ensure that their products are registered with the Arkansas State Plant Board, while the dealer must provide details about their facility and the pesticides they plan to dispense. This collaborative effort helps maintain safety standards and regulatory compliance in pesticide distribution.
The DP-42 form requires several key pieces of information:
Completing these sections accurately is crucial for the approval process.
Once the dealer receives approval through the DP-42 form, several responsibilities must be upheld:
These responsibilities are designed to promote safe practices in pesticide handling and distribution.
If any changes are necessary after the approval of the DP-42 form, the dealer must file an amendment to the application. It is important to communicate any alterations promptly to ensure continued compliance with state regulations. This process helps maintain the integrity of pesticide distribution and ensures that all parties involved are informed of the current operational status.
Incomplete Information: Failing to provide all required details can lead to delays. Each section of the form must be filled out completely. This includes the dealer’s name, complete mailing address, and contact numbers.
Incorrect EPA Establishment Number: Entering an incorrect or invalid EPA establishment number can result in the rejection of the application. Ensure that the number is accurate and corresponds to the specific facility.
Missing Signatures: Not signing the form is a common oversight. Both the dealer and the manufacturer must provide their signatures to validate the application.
Failure to List Products Properly: Listing products without complete brand names or EPA registration numbers may cause confusion. Be specific about each product being delivered.
Neglecting to Follow Instructions: Not adhering to the specific instructions provided on the form can lead to errors. It is important to read and understand all requirements before submitting.
The Arkansas DP-42 form is an essential document for those seeking permission to deliver and dispense bulk pesticides. Alongside this form, several other documents and forms are commonly utilized in the process of managing pesticides in Arkansas. Each of these documents serves a specific purpose and is integral to ensuring compliance with state regulations.
Each of these documents plays a crucial role in the safe handling and application of pesticides. Proper management of these forms ensures compliance with legal standards and promotes safety for both applicators and the public.
The Arkansas DP-42 form is similar to the EPA Form 3540-1, which is used for reporting pesticide production and sales. Both documents serve to ensure compliance with federal and state regulations regarding pesticide distribution. The DP-42 focuses on the delivery and dispensing of bulk pesticides to dealers, while the EPA Form 3540-1 requires manufacturers to report the quantities of pesticides produced and sold. Both forms aim to maintain safety and accountability in the pesticide industry.
Another document akin to the DP-42 is the USDA Pesticide Registration Application. This application is necessary for obtaining approval to sell a pesticide product. Like the DP-42, it requires detailed information about the product, including its intended use and safety measures. Both forms ensure that pesticides meet regulatory standards before reaching consumers and dealers, promoting public safety and environmental protection.
The Arkansas DP-42 form shares similarities with the State Pesticide Dealer License Application. This application is required for businesses that sell pesticides at retail. Both documents require information about the dealer and the pesticides involved. They ensure that dealers comply with state regulations and maintain proper records, which is essential for tracking pesticide sales and usage.
Additionally, the DP-42 is comparable to the Hazard Communication Standard (HCS) compliance documents. These documents are designed to inform employees about the chemicals they may encounter in the workplace. Both the DP-42 and HCS documents emphasize the importance of labeling and safety information to prevent accidents and ensure safe handling of pesticides and other hazardous materials.
The DP-42 form also resembles the Pesticide Applicator Certification Application. This application is used to certify individuals who apply pesticides professionally. Both documents require detailed information about the applicant and the pesticides used. They help ensure that individuals applying pesticides are knowledgeable about safety and application methods, thereby protecting public health and the environment.
Furthermore, the DP-42 is similar to the Bulk Pesticide Storage Permit Application. This application is required for facilities that store bulk pesticides. Both forms focus on the safe handling and storage of pesticides, outlining necessary precautions to prevent contamination and accidents. They help regulatory agencies monitor pesticide storage practices to ensure compliance with safety standards.
The DP-42 form can also be compared to the Pesticide Use Reporting Form. This form is used by applicators to report the pesticides they have applied. Both documents require detailed information about pesticide use and ensure accountability within the industry. They contribute to tracking pesticide usage patterns, which is essential for regulatory oversight and environmental protection.
Lastly, the DP-42 is akin to the Chemical Safety Data Sheet (CSDS). The CSDS provides critical safety information about chemicals, including pesticides. Both documents emphasize the importance of safety measures and proper handling procedures. They serve as resources for dealers and applicators to understand the risks associated with pesticides and ensure compliance with safety regulations.
When filling out the Arkansas DP-42 form, it is crucial to follow specific guidelines to ensure a smooth application process. Here are nine things to do and avoid:
Understanding the Arkansas DP-42 form is essential for anyone involved in the delivery and dispensing of bulk pesticides. However, several misconceptions can lead to confusion. Here are nine common misunderstandings about this form:
Being aware of these misconceptions can help ensure compliance with regulations and promote safe practices in the handling of pesticides. Understanding the requirements of the DP-42 form is crucial for anyone involved in this industry.
Here are key takeaways regarding the Arkansas DP-42 form:
Ensure all information is accurate and complete to avoid delays in approval.