The Arkansas DP-42 form is an official document used by the Arkansas State Plant Board's Division of Pesticides. It's designed for manufacturers and dealers seeking permission to deliver and dispense bulk pesticides at specific dealer facilities. To ensure compliance with regulations, the form lays out detailed instructions and required conditions for handling, labeling, and dispensing pesticides safely and legally.
If you're ready to manage bulk pesticides in Arkansas, click the button below to fill out your DP-42 form accurately and securely.
The Arkansas DP-42 form, overseen by the Arkansas State Plant Board's Division of Pesticides, serves as a critical document for the regulation of bulk pesticide distribution and use within the state. This application is designed for manufacturers who seek to deliver bulk pesticides to a dealer's facility, as well as for dealers aiming to dispense these pesticides to licensed applicators at specific locations. The form details a comprehensive set of conditions to ensure safety and regulatory compliance, such as the requirement for all products to be registered with the State Plant Board, clear labeling on containers, adherence to EPA guidelines and DOT regulations, and measures to prevent contamination or injury. Additionally, it outlines procedures for container handling, the designation of a resident agent for the service of process in certain cases, and the approval needed for metering devices, all aimed at maintaining high standards of safety and accountability in the handling of bulk pesticides. The submission and approval of this form signify a meticulous process aimed at safeguarding public health, the environment, and ensuring that the distribution and use of bulk pesticides within Arkansas are conducted responsibly and in accordance with state and federal guidelines.
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____________________________________
Getting permission to deliver and dispense bulk pesticides in Arkansas requires filling out the DP-42 form carefully. This form ensures that both the dealer and the manufacturer comply with the state's regulations to protect the environment and public health. The steps below will guide you through completing the form accurately to facilitate a smooth approval process.
After completing these steps, submit the form to the Arkansas State Plant Board. A signed copy will be returned to each location upon approval. This document serves as a critical step in ensuring your operations meet state guidelines and help maintain public safety and environmental health.
What is the Arkansas DP-42 form used for?
The Arkansas DP-42 form is an application that allows manufacturers to deliver bulk pesticides to a dealer's facility, and also grants dealers permission to dispense these bulk pesticides. It's a form required by the Arkansas State Plant Board, ensuring that both parties comply with state regulations, handle the pesticides safely, and properly label them for distribution to licensed applicators.
Who needs to complete the Arkansas DP-42 form?
Manufacturers seeking to deliver bulk pesticides to dealers within Arkansas, and dealers intending to dispense those bulk pesticides to licensed applicators, are required to fill out and submit this form. Both parties are responsible for providing detailed information about their operations, including facility locations and safety measures in place.
Where should the DP-42 form be submitted?
The completed form should be submitted to the Arkansas State Plant Board. The specific address is provided at the top of the form: P.O. Box 1069, Little Rock, Arkansas 72203. This ensures the form reaches the Division of Pesticides for review and approval.
What happens after submitting the form?
Upon submission, the form is reviewed by the Arkansas State Plant Board. If approved, a signed copy of the form is returned to each location indicated by the applicant as involved in the delivery or dispensing of the bulk pesticides. This approval is necessary for the legal distribution and handling of bulk pesticides at those locations.
Is there a fee associated with the DP-42 form?
The current version of the document does not specify a fee. However, it's advisable to contact the Arkansas State Plant Board directly for the most up-to-date information regarding any possible application fees or charges that may apply.
What are the key conditions listed on the DP-42 form?
Some of the main conditions include mandatory registration of all products with the State Plant Board by the manufacturer, clear labeling of containers by the dealer, adherence to EPA guidelines and DOT regulations, and provisions to prevent contamination. Additionally, the form mentions requirements for cleaning and relabeling containers before using them for different pesticides, and the need for all metering devices to be approved by the Weights and Measures Division of the Plant Board.
How often must the DP-42 form be renewed?
The form doesn't explicitly mention a validity period or a renewal requirement. Operations should assume it remains valid as long as there are no changes in the handling or dispensing locations, or the pesticides being handled. If any changes occur, an amendment to the application must be filed. Always consult directly with the Arkansas State Plant Board for specific guidelines regarding renewal or updates to the application.
Can changes be made to the DP-42 form after approval?
Yes, changes are permissible after the form has been approved. However, an amendment to the original application must be filed to document these changes officially. This ensures that the Arkansas State Plant Board has the most current information about the handling and dispensing of bulk pesticides at your facility.
What documentation is required alongside the DP-42 form?
While the form provides a thorough overview of the information needed, it doesn't specify additional documentation. It's reasonable to anticipate that evidence of compliance with EPA and DOT regulations, among other relevant certifications, may be requested. Direct consultation with the Arkansas State Plant Board is recommended to confirm any supplementary documents required for your application.
Where can one find more information or assistance with the DP-42 form?
For more details or assistance, contacting the Arkansas State Plant Board is the best course of action. You can reach out through their mailing address provided on the form, or visit their official website for contact numbers and email addresses. They can offer guidance, answer specific questions, and provide updated information pertinent to the application process.
Filling out the Arkansas DP-42 form, required for the delivery and dispensing of bulk pesticides, can sometimes be tricky. Certain mistakes are common among applicants, leading to delays and potential refusal. Being aware of these errors can help ensure a smoother submission process. Below are five common mistakes people make:
To avoid these errors, applicants should review each section of the form carefully and consult the guidelines provided by the Arkansas State Plant Board if any doubts arise. Complete and accurate submissions help facilitate a smoother approval process, ensuring that operations comply with state regulations and safeguarding public and environmental health.
When dealing with the Arkansas DP-42 form, which is essential for businesses intending to deliver or dispense bulk pesticides, it's important to be well-prepared with the necessary accompanying documents. The DP-42 isn't the only document required in this process; others play a crucial role in ensuring compliance with all regulations and standards set by the Arkansas State Plant Board and other regulatory bodies. Here is a list of documents often used alongside the Arkansas DP-42 form, each serving a unique purpose in the application process.
Understanding and preparing these documents is crucial for smooth operation and compliance in the pesticide distribution industry. Each form plays a vital role in ensuring the safety, legality, and environmental protection standards are met, thereby supporting the responsible distribution and use of pesticides. Dealers and manufacturers should familiarize themselves with these documents to navigate the regulatory landscape effectively and maintain best practices in handling bulk pesticides.
The "Application for Pesticide Registration" document, utilized in many states, shares significant similarities with the Arkansas DP-42 form. Both forms require manufacturers to provide comprehensive information about the pesticide, including the product name, EPA registration number, and manufacturer details. Additionally, they necessitate declarations concerning the pesticide's compliance with state regulatory requirements, a key parallel reflecting their roles in ensuring the safe handling and distribution of pesticides.
The "Notice of Arrival" form, mandated by the Environmental Protection Agency (EPA) for certain pesticide imports, mirrors the DP-42 form in its purpose of regulating substances that could impact environmental and public health. While the "Notice of Arrival" concerns the importation of pesticides, the DP-42 form focuses on the bulk delivery and dispensing at a local dealer's facility, yet both demand detailed product and distributor information to facilitate oversight.
Akin to the DP-42 form, the "Pesticide Dealer's License Application" also seeks to regulate the distribution and sale of pesticides within a jurisdiction. This document requires dealers to provide their business information, similar to the DP-42 form's requirement for dealer and manufacturer details. Both documents play crucial roles in ensuring that entities involved in the pesticide supply chain are authorized and monitored, thereby maintaining environmental safety and public health standards.
The "Pesticide Use Reporting Form," although primarily focused on the application and usage of pesticides, shares common objectives with the DP-42 form regarding regulatory compliance and safety. It requires detailed information on the pesticides used, paralleling the DP-42 form's requirement for specific details on the bulk pesticides to be delivered and dispensed. Both forms contribute to a comprehensive regulatory framework aimed at monitoring and managing pesticide distribution and use effectively.
Lastly, the "Facility Response Plan" form, required for facilities that store significant quantities of hazardous substances, including pesticides, has objectives similar to those of the DP-42 form. It demands detailed plans for handling potential spills or environmental contamination incidents, akin to the DP-42 form's guidelines for preventing contamination or injury from bulk pesticides. Both documents underscore the importance of preparedness and safety measures in the administration of chemical substances, protecting both human health and the environment.
When filling out the Arkansas DP-42 form, it's important to approach the process with careful attention to detail. Adhering to specific guidelines can ensure that your application is submitted correctly and efficiently. Here are some dos and don’ts to keep in mind:
There are several common misconceptions about the Arkansas Form DP-42, which is vital for entities looking to handle bulk pesticides. Clarifying these misunderstandings can help streamline the application process and ensure compliance with the Arkansas State Plant Board regulations.
In reality, both the manufacturer requesting to deliver bulk pesticides and the dealer seeking to dispense bulk pesticides must complete and submit the form. This ensures that all parties involved in the storage and distribution of bulk pesticides are properly registered and approved by the Arkansas State Plant Board.
However, any changes to the information originally provided, such as changes in bulk handling locations or products, require the submission of an amendment to the application. Continuous compliance involves updating the Plant Board on any significant alterations to operations or facilities.
While storage permission is a significant part of the form, it also covers the approval for facilities to dispense bulk pesticides to licensed applicators, ensuring the safe distribution and use of pesticides within Arkansas.
Approval for the Form DP-42 requires a review process by the Plant Board. A signed copy of the approved form is returned to each location upon successful review, confirming the authorization to handle bulk pesticides.
Each bulk container must be clearly labeled with specific information, including a warning that it contains pesticides. Furthermore, containers must be cleaned and relabeled when switching pesticides, ensuring safety and preventing cross-contamination.
As part of the compliance requirements, suitable sample points must be available on all containers to allow sampling by Plant Board personnel. These samples are crucial for verifying that the pesticides meet safety and quality standards.
Understanding these key aspects of the Form DP-42 can help ensure that manufacturers and dealers are properly informed and compliant with Arkansas regulations concerning the handling of bulk pesticides.
When applying for permission to deliver and dispense bulk pesticides in Arkansas, careful attention must be paid to the Arkansas DP-42 form. Below are key takeaways for successful completion and utilization:
Note: Amendments to the application are required if there are any changes desired after the initial approval. This process is crucial for maintaining compliance and ensuring the safe handling and distribution of bulk pesticides.
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