
ARIZONA DEPARTMENT OF WEIGHTS AND MEASURES PUBLIC WEIGHMASTER APPLICATION
4425 W Olive Avenue, Suite 134, Glendale AZ 85302-3844 LICENSE FEE = $48
Phoenix Metro assistance: 602-771-4935
Outside Phx Metro: 1-800-277-6675
FAX: 623-939-8586 PLEASE PRINT
APPLICANT NAME: BIRTH DATE:
(Must be at least 18 years old)
BUSINESS NAME: PHONE: FAX:
BUSINESS ADDRESS: CITY: ZIP:
PHYSICAL LOCATION:
SCALE OWNER INFORMATION (if different from business name above):
SCALE OWNER NAME: BMF#: ADDRESS:
SCALE TYPE: VEHICLE SCALE OTHER DECK/PLATFORM SIZE: CAPACITY: . lbs x _____ ______
OTHER LOCATIONS WHERE YOU WILL BE A PUBLIC WEIGHMASTER:
1 ADDRESS: CITY: ZIP:
SCALE OWNER NAME: BMF#: ADDRESS:
SCALE TYPE: VEHICLE SCALE OTHER DECK/PLATFORM SIZE: CAPACITY: . lbs x _____ ______
2 ADDRESS: CITY: ZIP:
SCALE OWNER NAME: BMF#: ADDRESS:
SCALE TYPE: VEHICLE SCALE OTHER DECK/PLATFORM SIZE: CAPACITY: . lbs x _____ ______
DESCRIBE YOUR EXPERIENCE IN THE USE OF THE SCALE INDICATED ABOVE:
LIST CURRENTLY-LICENSED DEPUTY PUBLIC WEIGHMASTERS (Deputy Public Weighmaster application is required for individuals not currently licensed):
NAME BIRTH DATE NAME BIRTH DATE SEAL REQUEST (check one)
STAMP
HAND HELD PRESS
DESK TOP PRESS
ARS 41-2093 requires a Public Weighmaster to have a valid Public Weighmaster license. In addition, applicants must pass a written examination before they can perform Public Weighmaster duties.
This is to certify that I have full knowledge of Title 41, Chapter 15 and Arizona Administrative Code Title 20, chapter 2 as it relates to Public Weighmaster licensing and duties; and any other
Department regulations relating to Public Weighmaster and will, upon licensure, operate in accordance with said laws, rules and regulations.
APPLICANT MUST ATTACH A DRAFT OF THE WEIGHT CERTIFICATE THAT WILL BE USED. DEPT USE: Test Date:
Score:
License Issued:
APPLICANT SIGNATURE: DATE:
DWM156(3-00)