Official Arkansas Dp 42 Template in PDF Customize Form

Official Arkansas Dp 42 Template in PDF

The Arkansas DP 42 form is an essential document for businesses involved in the distribution and handling of bulk pesticides within the state. It serves as an application for manufacturers and dealers seeking permission to deliver and dispense bulk pesticides at specific facilities, detailing compliance with regulations and safety measures. To ensure your business adheres to these guidelines, complete and submit the form to the Arkansas State Plant Board for approval.

Ready to ensure the compliance of your bulk pesticide operations? Click the button below to fill out your Arkansas DP 42 form today.

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In the realm of agricultural and pest control management within Arkansas, the Form DP-42 emerges as a crucial document, underscoring the structured approach towards the handling and dispensation of bulk pesticides. Issued by the Arkansas State Plant Board, specifically through its Division of Pesticides, this form serves as an application for entities aiming to deliver or dispense bulk pesticides at a dealer's facility. Applicants are required to navigate through a detailed submission process, encapsulating a commitment to various regulatory compliances, including EPA guidelines and Department of Transportation (DOT) regulations. Key requirements outlined in the form include product registration with the State Plant Board, clear labeling and sealing of containers to prevent tampering, and adequate measures for contamination prevention. Additionally, the form mandates the provision for sample access, ensuring the material aligns with the label descriptions, alongside obligations for container cleanliness and relabeling before dispensing different pesticides. The document also elucidates responsibilities for overall operation management and conditions for manufacturer-dealer relationships, including the appointment of a resident agent for manufacturers without direct representation. This framework not only facilitates the safe and regulated distribution of pesticides but also underscores the accountability structures in place for both manufacturers and dealers within Arkansas's pesticide regulatory landscape.

Arkansas Dp 42 Preview

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

_____________________________________________________________(______)____________________

Complete Mailing AddressTelephone 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____________________________________

File Information

Fact Name Description
Purpose of Form DP-42 Used by manufacturers to request permission to deliver bulk pesticides and by dealers to request permission to dispense bulk pesticides at specific locations in Arkansas.
Governing Body The Arkansas State Plant Board is responsible for the oversight and approval of the Form DP-42 applications.
Key Conditions for Approval Conditions include product registration with the State Plant Board, clear labeling on containers, compliance with EPA and DOT regulations, and provisions for preventing contamination.
Governing Laws Approval and regulation under this form are governed by Arkansas state laws related to pesticide control, EPA guidelines, and Department of Transportation regulations concerning the handling of bulk pesticides.

Detailed Instructions for Using Arkansas Dp 42

To ensure the proper handling and distribution of bulk pesticides in Arkansas, it's critical for dealers and manufacturers to seek permission through the Arkansas State Plant Board by filling out the Form DP-42. This form ensures that both parties comply with state regulations regarding the distribution, labeling, and handling of pesticides. By carefully following the steps outlined, dealers and manufacturers can ensure their application is correctly submitted for approval. This process contributes to the safe management of pesticides, safeguarding the environment, and public health.

  1. Enter the EPA Establishment Number at the designated space at the beginning of the form.
  2. Under the Dealer's Name section, provide the complete name of the dealer and the contact phone number, including area code.
  3. Fill in the Dealer’s complete mailing address, including the city, state, and zip code.
  4. Under the Manufacturer’s or Registrant’s Name section, enter the name of the manufacturer or registrant and their contact telephone number, including area code.
  5. Provide the Manufacturer's complete mailing address, including city, state, and zip code.
  6. Detail the specific locations where the bulk pesticides will be delivered and dispensed. Include the full address and any necessary descriptions.
  7. For each pesticide product to be handled, list the complete brand name, container size in gallons, and the EPA Registration Number in the provided sections.
  8. Identify the designated applicator(s) to be serviced by the dealer, including their names or company names.
  9. Name the Manufacturer’s Resident Agent and provide their full address.
  10. Provide the name of the Dealer and the Person in Charge of the operation, along with their complete addresses and phone numbers.
  11. Review all provided information for accuracy and completeness. Changes after approval will require an amendment to this application.
  12. Ensure that both the Dealer and Manufacturer sign and date the bottom of the form, indicating their agreement and compliance with the stated conditions.
  13. Submit the completed Form DP-42 to the Arkansas State Plant Board at the address provided at the top of the form. Keep a copy for your records and wait for a signed copy to be returned upon approval.

After submitting the form, it will be reviewed by the Arkansas State Plant Board. Upon approval, a signed copy of the form will be returned, which grants the necessary permissions for the delivery and dispensing of bulk pesticides. It's important to maintain this document as part of your records, as compliance with state regulations is essential for operating your business. If there are any changes to your operation or if new products are being introduced, remember to file an amendment to this application to keep all permissions current.

Essential Queries on Arkansas Dp 42

What is the purpose of the Arkansas DP-42 form?

The Arkansas DP-42 form is used to request permission from the Arkansas State Plant Board for both the delivery of bulk pesticides to a dealer's facility and the permission for the dealer to subsequently dispense these bulk pesticides. This process is essential to ensure that all parties comply with regulatory standards for the handling, labeling, and distribution of pesticides within the state. By completing and submitting this application, manufacturers and dealers declare their intention to adhere to guidelines set forth by the State Plant Board, the Environmental Protection Agency (EPA), and the Department of Transportation (DOT), among others, to safeguard public health and the environment.

Who needs to fill out the DP-42 form?

The DP-42 form must be filled out by pesticide manufacturers or registrants who seek to deliver bulk pesticides to a dealer in Arkansas, and by dealers who wish to receive and dispense these bulk pesticides at their facilities. The form serves as a formal request for approval of such activities and outlines the responsibilities of both parties in ensuring the safe handling and distribution of the pesticides. It is crucial for anyone involved in the bulk delivery and dispensing of pesticides within the state to complete this form to obtain the necessary permissions.

What are the key requirements outlined in the DP-42 form?

The form highlights several essential requirements including the registration of all products with the State Plant Board by the manufacturer, clear marking of the containers with warnings and other necessary information, adherence to EPA guidelines and DOT regulations for handling bulk pesticides, making provisions to prevent contamination or injury, and responsibility for the overall operation of the site by the designated person. Additionally, it mandates that containers be properly cleaned and relabeled before being used for different pesticides, and that all metering devices receive approval from the Weights and Measures Division of the Plant Board.

How is the DP-42 form submitted to the Arkansas State Plant Board?

To submit the DP-42 form to the Arkansas State Plant Board, the completed application must be sent to the provided address in Little Rock, Arkansas. This can be done via mail. Once the application is received and reviewed for compliance with the outlined standards and regulations, a signed copy of the approval will be returned to each specified location. This ensures that the manufacturer and dealer are officially authorized to proceed with the delivery and dispensing of bulk pesticides at the designated facilities.

What happens if changes are needed after the approval of the DP-42 form?

If any changes are required after the DP-42 form has been approved, an amendment to the application must be filed with the Arkansas State Plant Board. This could involve changes to the handling location, the products being handled, the applicators being serviced, or any other significant modification to the initially approved arrangement. Filing an amendment ensures that the State Plant Board is kept informed of any alterations to the operational details or responsibilities, allowing for continued compliance with state regulations and the maintenance of safe pesticide handling practices.

Common mistakes

When filling out the Arkansas DP-42 form, which is crucial for the delivery and dispensing of bulk pesticides, many people make mistakes that can delay or impact the approval process. Here’s a list of common errors:

  1. Not providing complete information for both the dealer and the manufacturer, including full mailing addresses and telephone numbers. Every field needs to be accurately filled out to ensure there are no delays in processing.
  2. Failing to clearly outline the bulk handling location with specificity. A vague or incomplete address can lead to confusion or misinterpretation regarding the site intended for pesticide dispensing.
  3. Omitting or inaccurately listing the EPA establishment number. This number is critical for identifying the facility in compliance with environmental regulations.
  4. Skipping the details about the products to be dispensed, including the complete brand name, size, and EPA registration number of each container. Each product detail helps ensure that only approved pesticides are being handled.
  5. Ignoring the need to designate a manufacturer’s agent when the dealer is not acting as the agent. This mistake can complicate legal accountability and communication.
  6. Forgetting to sign and date the application. Both the dealer and manufacturer must provide signatures to validate the request. An unsigned application is incomplete and will not be processed.

Avoiding these mistakes can streamline the approval process, ensuring that all regulatory requirements are met for safe and legal pesticide handling.

Documents used along the form

When handling pesticides and related documentation in Arkansas, the Arkansas DP-42 form serves as a crucial component of a comprehensive compliance and regulatory framework. This application facilitates the lawful delivery and dispensing of bulk pesticides, ensuring that dealers and manufacturers adhere to the state’s standards. Alongside the DP-42 form, there are several other essential documents and forms that play significant roles in the pesticide regulation process, enhancing safety, accountability, and environmental protection.

  • Form E-1, Pesticide/Device Establishment Registration: Required for any facility involved in the production or distribution of pesticides or devices in Arkansas, providing the State Plant Board with critical location and operational details.
  • Form F-1, Pesticide Product Registration Application: Necessary for the legal distribution, sale, or use of a pesticide product within the state, ensuring the product meets safety and efficacy standards.
  • Form AG-136, Pesticide Complaint Form: Allows individuals to report misuse or adverse effects of pesticides, facilitating investigation and enforcement by the State Plant Board.
  • Annual Pesticide Dealer License: Required for any entity selling or distributing pesticides in Arkansas, ensuring they meet regulatory requirements and standards.
  • Form P-1, Pesticide Applicator License Application: Needed for individuals who apply pesticides commercially, ensuring they have the necessary training and knowledge to do so safely.
  • Form P-4, Continuing Education Unit (CEU) Reporting Form: Enables licensed applicators to document their participation in approved continuing education programs for license renewal.
  • Form NPDES, National Pollutant Discharge Elimination System Permit Application: Required for facilities that could discharge pesticides into waterways, ensuring compliance with federal clean water regulations.
  • Hazardous Material Transportation Forms: Essential for entities transporting hazardous materials, including certain pesticides, ensuring compliance with Department of Transportation regulations.
  • Emergency Response Plan: A document detailing procedures for handling accidents or spills involving pesticides, crucial for preventing harm and ensuring rapid, effective response.
  • Inventory Records and Transaction Receipts: Keep track of pesticide stocks and sales, aiding in regulatory compliance and inventory management.

Each of these documents plays a vital role in the comprehensive scheme of pesticide regulation and management. By ensuring that these forms and documents are accurately completed and maintained, stakeholders in Arkansas can contribute to the safe, responsible, and effective use of pesticides, protecting public health, the environment, and agricultural interests.

Similar forms

The Arkansas DP-42 form shares similarities with the Environmental Protection Agency's (EPA) Pesticide Registration Application. Both require detailed labeling and packaging information, ensuring that pesticides are properly labeled with manufacturer details, safety warnings, and product composition. These documents ensure that all pesticides introduced into the market are registered and meet safety guidelines set forth by federal and state regulators, aiming to protect public health and the environment by regulating the distribution and use of pesticides.

Another comparable document is the Department of Transportation (DOT) Hazardous Materials Registration. Like the DP-42, this registration mandates compliance with specific handling and transportation regulations. Both documents are geared toward ensuring that hazardous materials, including bulk pesticides, are transported in a manner that minimizes risks of accidents, leaks, or contamination. They require that stakeholders adhere to strict guidelines to prevent pollution and protect all involved in the transportation chain.

The Occupational Safety and Health Administration (OSHA) Hazard Communication Standard (HCS) Safety Data Sheet (SDS) submission bears resemblance to the DP-42 form as well. Each document mandates the disclosure of harmful effects and safety precautions related to chemical products. The intent behind both is to guarantee that individuals working with or near hazardous substances are aware of their properties, potential hazards, and the necessary safety measures to take to protect themselves and their environment.

State-specific Bulk Storage Application forms, similar to the one administered by the New York State Department of Environmental Conservation, echo the DP-42 form's intent. These forms regulate the storage of large quantities of hazardous chemicals, including pesticides, to prevent leaks and environmental contamination. Like the DP-42, these applications require information on the storage facility, safety measures, and emergency response plans, ensuring safe storage practices are in place.

The Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) Pesticide Establishment Registration form is also akin to the DP-42. FIFRA necessitates that production facilities, including those that package or label pesticides, are registered and monitored. Both this registration and the DP-42 aim to oversee the distribution chain of pesticides, from manufacturing down to retail, ensuring compliance with regulations that safeguard public health and the environment.

The Agricultural Chemical Containment Facilities Permit, which some states require, mirrors the requirements seen in the DP-42. These permits focus on the containment and spill prevention measures that facilities must have if they handle pesticides or fertilizers. Similar to the DP-42, the emphasis is on preventing contamination of soil and water resources and ensuring that chemicals are handled in a manner that protects public health and the environment.

Dos and Don'ts

When filling out the Arkansas DP-42 form, attention to detail is crucial for a smooth submission process. Here are some dos and don'ts to guide you along the way.

Do:
  • Read all instructions carefully before you start filling out the form to avoid any mistakes that could delay approval.
  • Ensure that all information is accurate, especially the EPA Establishment Number, as it's vital for traceability and compliance.
  • Use clear and legible handwriting if filling out the form manually, or ensure that typed information is correctly aligned and printed.
  • Verify that all pesticides mentioned are registered with the State Plant Board by the manufacturer to comply with the first condition.
  • Double-check that all containers are marked clearly and contain the proper labeling that meets regulation standards, including the name and address of the dealer and the warning phrase.
  • Sign and date the application as this is a necessary step for both the dealer and the manufacturer, indicating your agreement with the terms and responsibility for the information provided.
Don't:
  • Leave any sections blank. If a section doesn't apply, write 'N/A' (Not Applicable) instead of leaving it empty to show that you didn't overlook it.
  • Forget to include the complete mailing address and telephone number for both the dealer and the manufacturer, as this information is crucial for communication.
  • Avoid making unauthorized amendments to the form after it's been approved. If changes are needed, file an amendment as directed in the note at the end of the form.

Following these guidelines can help ensure that your application is complete, accurate, and submitted in compliance with Arkansas regulations for handling bulk pesticides. A little attention to detail can go a long way in making the process efficient and effective.

Misconceptions

Understanding the Arkansas DP-42 form and its purpose can sometimes be challenging, leading to several common misconceptions. Below, we address five of the most prevalent misunderstandings surrounding this document.

  • The DP-42 form is only used for the storage of pesticides. This misunderstanding overlooks the form's primary function. It is actually utilized for obtaining permission to both deliver and dispense bulk pesticides at a dealer's facility, ensuring that those handling and distributing these substances are properly authorized and the substances are managed safely and in accordance with state guidelines.
  • Approval is granted based solely on the information provided in the form. While the information supplied on the DP-42 form is crucial for its processing, approval also depends on adherence to a set of conditions outlined by the Arkansas State Plant Board. These conditions include proper product registration, stringent labeling, secure container sealing to prevent tampering, and compliance with EPA and DOT regulations, among others. Approval is not just administrative but also conditional on these practices.
  • Any dealer can receive and dispense bulk pesticides once approved. The reality is more complex. Dealers must not only be approved via the DP-42 form but must also meet specific requirements related to the handling, storage, and dispensing of pesticides. This includes maintaining adequate provisions to prevent contamination or injury and ensuring that containers and metering devices are approved by the relevant authorities, reflecting a commitment to safety and regulatory compliance beyond mere approval.
  • The form is a one-time submission with perpetual validity. Quite the contrary, the DP-42 form's approval is attached to specific conditions and locations as stated in the document. Any changes to these, such as a new handling location or a different pesticide product, require filing an amendment to the original application. This ensures all information remains current and accurate, maintaining the safety and regulatory integrity of pesticide handling operations.
  • It’s unnecessary for dealers to clean containers before using them for different pesticides if they're not switching products immediately. This overlooks an essential safety protocol. Before any container is used for a different pesticide, it must be thoroughly cleaned and relabeled by the dealer, as specified in the DP-42 guidelines. This step is critical in preventing cross-contamination, ensuring the safety of applications, and complying with both state and federal regulations regarding pesticide handling.

Clarifying these misconceptions is crucial for maintaining the safety and efficacy of pesticide handling and distribution practices in Arkansas. By adhering to the guidelines and requirements outlined in the DP-42 form and understanding its broader implications, dealers can contribute to safer pesticide use and environmental protection.

Key takeaways

Filling out and using the Arkansas DP-42 form is essential for dealers and manufacturers who aim to deliver and dispense bulk pesticides in Arkansas. Here are some key takeaways to ensure the process is smooth and compliant with regulations:

  • The DP-42 form is a requirement by the Arkansas State Plant Board for anyone looking to deliver bulk pesticides to a dealer's facility, as well as for dealers intending to dispense these pesticides.
  • All pesticides intended for bulk delivery and dispensation must be registered with the State Plant Board by the manufacturer, ensuring they meet state regulations.
  • It is mandatory for containers used to dispense the pesticides to be clearly marked with the dealer's name, address, and a warning that indicates the presence of pesticides, ensuring visibility and safety.
  • A complete product label, including the manufacturer’s name and address as provided by the manufacturer, must be attached to all containers, guaranteeing all necessary information is accessible.
  • Dealers must abide by EPA guidelines and Department of Transportation (DOT) regulations when handling bulk pesticides, ensuring compliance with federal and state safety standards.
  • Adequate provisions for the safe handling of pesticides must be made by the dealer to prevent contamination or injury to people, livestock, and crops, highlighting the importance of safety measures.
  • In cases where the dealer is not acting as the manufacturer’s agent, the manufacturer must designate a resident agent for service of process, establishing a direct point of contact within the state.
  • The dealer is responsible for thoroughly cleaning and relabeling containers before they are repurposed for different pesticides, preventing cross-contamination and ensuring safety.

Before validation of the DP-42 form by the Arkansas State Plant Board, both the dealer and the manufacturer must sign the application, underlining their agreement and responsibility towards maintaining compliant operations. Should any changes be required after the initial approval, an amendment to the application must be filed, indicating the dynamic nature of pesticide dispensation operations.

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