The Arkansas DP-42 form is an application used to request permission for delivering bulk pesticides to a dealer's facility and for the dealer to dispense those pesticides. This form is essential for ensuring compliance with state regulations and safe handling practices. Completing and submitting the DP-42 to the Arkansas State Plant Board is a crucial step for both manufacturers and dealers in the pesticide industry.
The Arkansas DP-42 form is an essential document for those involved in the distribution and dispensing of bulk pesticides within the state. This application, managed by the Arkansas State Plant Board, serves two primary purposes: it grants permission for manufacturers to deliver bulk pesticides to a dealer's facility and allows the dealer to dispense these pesticides to licensed applicators. To complete the form, applicants must provide detailed information, including the dealer's name, contact details, and the manufacturer's information. Additionally, the form outlines specific requirements that must be met, such as proper labeling of containers, compliance with EPA guidelines, and ensuring safe handling practices to protect people, livestock, and crops. Each application is subject to approval, and once granted, a signed copy will be returned to the dealer. This process is vital in maintaining safety standards and regulatory compliance in the pesticide distribution chain.
The Arkansas DP-42 form serves as an application for permission to deliver bulk pesticides to a dealer’s facility. Additionally, it grants the dealer the authority to dispense these bulk pesticides to licensed applicators in Arkansas. This form ensures that all parties comply with state regulations regarding pesticide handling and safety.
Both manufacturers and dealers of pesticides are required to complete the DP-42 form. The manufacturer requests permission to deliver bulk pesticides, while the dealer seeks approval to install dispensing facilities at their location. This collaborative effort helps maintain safety and compliance with state laws.
Essential information includes:
Providing accurate and complete information is crucial for the approval process.
Approval of the DP-42 form comes with several conditions, including:
These conditions ensure safety and compliance with regulations.
The completed DP-42 form must be submitted to the Arkansas State Plant Board. After review and approval, a signed copy of the form will be returned to the dealer and manufacturer. This process formalizes the permission granted for pesticide delivery and dispensing.
If any changes are required after the approval of the DP-42 form, an amendment to the application must be filed. This ensures that all modifications are documented and compliant with state regulations, maintaining transparency and accountability.
Dealers are responsible for several key aspects, including:
These responsibilities are vital for maintaining safety standards in pesticide handling.
For further inquiries regarding the DP-42 form or other pesticide-related questions, individuals can contact the Arkansas State Plant Board directly. They can provide guidance, clarify any concerns, and assist with the application process.
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____________________________________
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When filling out the Arkansas DP-42 form, it's essential to follow certain guidelines to ensure a smooth application process. Here are eight things to do and avoid:
Incomplete Information: Failing to provide all required details can lead to delays. Make sure to fill in every section, including the EPA establishment number, dealer’s name, and complete mailing address.
Missing Signatures: Not signing the form can result in rejection. Ensure that both the dealer and manufacturer sign and date the application before submission.
Incorrect Container Information: Listing incorrect product names or EPA registration numbers can cause significant issues. Double-check that all products are accurately represented and comply with registration requirements.
Neglecting to Follow Instructions: Ignoring the specific instructions for labeling and container handling can lead to compliance problems. Adhere closely to the guidelines regarding labeling and safety measures.