Outline
The Arkansas DP-42 form plays a crucial role in the regulation of bulk pesticides in the state. This application is designed for manufacturers and dealers who wish to deliver and dispense bulk pesticides at specific facilities. It outlines essential information, including the names and addresses of the dealer and manufacturer, as well as their contact details. The form also requires the dealer to comply with several important conditions to ensure safe handling and dispensing of pesticides. These conditions include proper labeling of containers, adherence to Environmental Protection Agency (EPA) guidelines, and measures to prevent contamination. Additionally, the form mandates that all products must be registered with the Arkansas State Plant Board. By submitting the DP-42 form, dealers and manufacturers seek permission to operate within the legal framework, thus promoting public safety and environmental protection. Upon approval, a signed copy is returned to each location, allowing for transparency and accountability in the pesticide distribution process.
Sample - Arkansas Dp 42 Form
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
Instructions: 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 Address Telephone Number
________________________________________________________________________________________
City State Zip Code
________________________________________________________________________________________
Manufacturer’s or Registrant’s Name
_____________________________________________________________(______)____________________
Complete Mailing Address Telephone Number
________________________________________________________________________________________.
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 ________________________________
Title _______________________________________
Date _______________________________________
Signature____________________________________
Form Information
| Fact Name | Details |
|---|---|
| Form Purpose | The DP-42 form is used to apply for permission to deliver bulk pesticides to a dealer's facility and for the dealer to dispense those pesticides. |
| Governing Authority | This form is governed by the Arkansas State Plant Board regulations. |
| Submission Process | Applicants must complete the form and submit it to the Arkansas State Plant Board for approval. |
| Return of Approval | A signed copy of the approved application will be returned to each location once it is approved. |
| Labeling Requirements | All containers must be plainly marked with the dealer's name and a warning indicating the presence of pesticides. |
| Sample Points | Containers must include sample points for State Plant Board personnel to collect representative samples. |
| Compliance with Regulations | Dealers must comply with EPA guidelines and all Department of Transportation (DOT) regulations regarding bulk pesticide handling. |
Detailed Guide for Filling Out Arkansas Dp 42
Completing the Arkansas DP-42 form is a straightforward process that requires attention to detail. After submitting the form to the Arkansas State Plant Board, a signed copy will be returned upon approval. Follow these steps to ensure accurate completion of the application.
- Obtain the Arkansas DP-42 form from the Arkansas State Plant Board website or office.
- Fill in the EPA Establishment Number at the top of the form.
- Provide the Dealer’s Name and Complete Mailing Address, including city, state, and zip code.
- Enter the Telephone Number for the dealer.
- Fill in the Manufacturer’s or Registrant’s Name and their Complete Mailing Address, including city, state, and zip code.
- Provide the Telephone Number for the manufacturer or registrant.
- Indicate the bulk handling location by specifying the address where the pesticides will be delivered.
- List the products to be dispensed, including the complete brand name, container size, and EPA registration number for each container.
- Identify the applicators to be serviced by the dealer.
- Designate the manufacturer’s resident agent and provide their address.
- Enter the person in charge of the dealer’s operation along with their address and phone number.
- Review the form for accuracy and completeness.
- Sign and date the form in the designated areas for both the dealer and the manufacturer.
- Submit the completed form to the Arkansas State Plant Board.
Obtain Answers on Arkansas Dp 42
-
What is the purpose of the Arkansas DP-42 form?
The Arkansas DP-42 form serves as an application for permission to deliver bulk pesticides to a dealer’s facility. It also grants permission for the dealer to dispense these bulk pesticides to licensed applicators in Arkansas. The form ensures compliance with state regulations concerning the handling and distribution of pesticides.
-
Who needs to fill out the DP-42 form?
The form must be completed by both the manufacturer of the pesticides and the dealer who will dispense them. Each party must provide their contact information, including mailing addresses and telephone numbers, to facilitate communication and ensure compliance with state regulations.
-
What information is required on the DP-42 form?
The form requires several key pieces of information:
- EPA Establishment Number
- Dealer’s Name and Complete Mailing Address
- Telephone Number of the Dealer
- Manufacturer’s or Registrant’s Name and Complete Mailing Address
- Products to be dispensed, including brand names and EPA Registration Numbers
- Location of the bulk handling facility
- Name and address of the person in charge of the dealer’s operation
-
What are the conditions that must be met for approval?
Approval of the DP-42 form is contingent upon meeting several conditions, including:
- All products must be registered with the State Plant Board.
- Containers must be clearly marked with the dealer's name and a warning about the pesticide contents.
- Containers must bear a complete label as registered, including the manufacturer's information.
- All containers must allow for sampling by State Plant Board personnel.
- Dealers must follow EPA guidelines and DOT regulations regarding bulk pesticide handling.
-
What happens if changes are needed after approval?
If any changes are necessary after the approval of the DP-42 form, an amendment to the application must be filed. This ensures that the Arkansas State Plant Board is kept informed of any modifications that could affect compliance or operational procedures.
-
How is the DP-42 form submitted and approved?
The completed form must be submitted to the Arkansas State Plant Board. Upon approval, a signed copy will be returned to each location specified in the application. This signed copy serves as official documentation of the dealer's permission to operate under the specified conditions.
Common mistakes
Filling out the Arkansas DP-42 form requires attention to detail. One common mistake is failing to provide complete and accurate contact information. The form requests both the dealer's and manufacturer's complete mailing addresses and telephone numbers. Omitting any part of this information can lead to delays in processing the application or even a rejection. It is crucial to double-check that all fields are filled in correctly.
Another frequent error involves the mislabeling of products. The form specifies that all products must be registered with the State Plant Board. If a dealer lists products that are not registered, this can result in significant legal and operational issues. Ensuring that the correct EPA registration numbers are included for each product is essential. Inaccurate or incomplete product information can lead to confusion and potential violations of state regulations.
Many applicants also overlook the requirement for proper labeling on containers. The instructions indicate that all containers must be plainly marked with the dealer's name and address, along with a warning that indicates the presence of pesticides. Failure to comply with this labeling requirement not only violates the terms of the application but may also pose safety risks. Containers should be clearly marked to ensure that they are handled correctly and safely.
Lastly, individuals often neglect to designate a responsible person in charge of the operation. The form explicitly states that the dealer and the person in charge are responsible for the overall operation of the location. Not identifying this individual can create accountability issues and complicate compliance with state regulations. It is important to designate someone who is knowledgeable and can manage the operation effectively.
Documents used along the form
The Arkansas DP-42 form is a crucial document for those involved in the delivery and dispensing of bulk pesticides in the state. However, it is often accompanied by several other forms and documents that help ensure compliance with regulations and facilitate the process. Below is a list of related documents that are commonly used alongside the DP-42.
- EPA Registration Certificate: This document verifies that a pesticide product has been registered with the Environmental Protection Agency. It confirms that the product meets safety and efficacy standards before it can be sold or distributed.
- Dealer License: A dealer license is required for businesses that sell pesticides. This license ensures that the dealer complies with state and federal regulations regarding the sale and distribution of pesticides.
- Labeling Requirements Document: This document outlines the specific labeling requirements for pesticide containers. It ensures that all necessary information, such as safety warnings and usage instructions, is clearly presented on the product labels.
- Safety Data Sheet (SDS): An SDS provides detailed information about the properties of a chemical product, including hazards, handling instructions, and emergency measures. It is essential for ensuring the safe use of pesticides.
- Training Certification: This certification verifies that individuals involved in handling and applying pesticides have completed necessary training programs. It is crucial for ensuring that all personnel are knowledgeable about safe practices and regulations.
- Inspection Report: An inspection report documents the findings of inspections conducted by regulatory authorities. It may include compliance status, any violations found, and recommendations for corrective actions.
In summary, these documents play a vital role in the regulatory framework surrounding pesticide distribution and usage. They help ensure that all parties involved adhere to safety standards and legal requirements, ultimately protecting public health and the environment.
Similar forms
The Arkansas DP-42 form is an important document used for the delivery and dispensing of bulk pesticides. It shares similarities with several other forms that serve related purposes in the realm of agricultural and pesticide management. Below are five documents that are comparable to the DP-42 form, each serving a unique but related function.
- EPA Form 3540-1: This form is used for the registration of pesticides with the Environmental Protection Agency (EPA). Like the DP-42, it ensures that pesticides are properly registered before they can be sold or distributed, emphasizing safety and compliance.
- State Pesticide License Application: This document is required for individuals or businesses seeking to obtain a pesticide applicator's license. Similar to the DP-42, it verifies that the applicant meets the necessary qualifications and adheres to state regulations regarding pesticide use.
- Bulk Pesticide Storage Permit: This permit is necessary for facilities that store bulk pesticides. It shares the same objective as the DP-42 in ensuring that storage practices comply with safety standards to prevent contamination and accidents.
- Pesticide Dealer License Application: This application is for businesses that wish to sell pesticides. Like the DP-42, it requires detailed information about the dealer and their operations, ensuring they are equipped to handle and dispense pesticides safely.
- Pesticide Use Reporting Form: This form is used to report the application of pesticides in agricultural settings. It is similar to the DP-42 in that it promotes accountability and tracking of pesticide usage to ensure compliance with regulations and protect public health.
Understanding these forms can help ensure that all parties involved in the handling of pesticides are compliant with the necessary regulations, promoting safety for both people and the environment.
Dos and Don'ts
When filling out the Arkansas DP-42 form, attention to detail is crucial. Below is a list of things to do and avoid to ensure a smooth application process.
- Do provide accurate information in all sections of the form.
- Do ensure that all products are registered with the State Plant Board.
- Do clearly label all containers with the dealer's name and a warning about pesticide contents.
- Do include the manufacturer's name and address on the product labels.
- Do make sure containers have suitable sample points for state personnel.
- Don't leave any sections of the form incomplete.
- Don't forget to seal filling inlets to prevent tampering.
- Don't overlook the need for compliance with EPA and DOT regulations.
- Don't use containers for different pesticides without thorough cleaning and relabeling.
By following these guidelines, applicants can avoid common pitfalls and streamline the approval process for delivering bulk pesticides in Arkansas.
Misconceptions
Understanding the Arkansas DP-42 form is crucial for those involved in the delivery and dispensing of bulk pesticides. However, several misconceptions can lead to confusion. Here are five common misconceptions:
- The DP-42 form is only for manufacturers. This form is required for both manufacturers and dealers. Dealers need permission to dispense pesticides, and manufacturers must request delivery permission.
- Once submitted, the form is automatically approved. Submission does not guarantee approval. The Arkansas State Plant Board reviews each application, and a signed copy is returned only upon approval.
- All pesticides can be delivered without restrictions. The form includes specific conditions that must be met, such as proper labeling and compliance with EPA and DOT regulations. Failure to comply can result in penalties.
- Changes can be made after approval without any formal process. If changes are needed, an amendment to the application must be filed. Informal changes are not permitted.
- The form does not require detailed information about products. The DP-42 form requires a complete list of products, including their sizes and EPA registration numbers. This ensures that all pesticides are properly documented and tracked.
By clarifying these misconceptions, stakeholders can navigate the application process more effectively and ensure compliance with state regulations.
Key takeaways
When filling out the Arkansas DP-42 form, it is essential to follow specific guidelines to ensure compliance and facilitate the approval process. Here are some key takeaways to keep in mind:
- Complete Information is Crucial: Ensure that all sections of the form are filled out accurately. This includes the dealer's name, contact information, and the manufacturer's details. Missing or incorrect information can lead to delays in processing.
- Labeling Requirements: All containers that will dispense pesticides must be clearly labeled. The dealer's name and address should be prominently displayed, along with a warning indicating the presence of pesticides. This is vital for safety and compliance.
- Adherence to Regulations: The dealer must comply with all EPA guidelines and DOT regulations regarding the handling of bulk pesticides. This includes proper storage and safety measures to prevent contamination or harm.
- Amendments for Changes: If any changes are needed after the application has been approved, an amendment must be filed. This is important to maintain compliance and ensure that all operations are up to date.