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ARIZONA DEPARTMENT OF AGRICULTURE - PLANT SERVICES DIVISION (Arizona)

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ARIZONA DEPARTMENT OF AGRICULTURE - PLANT SERVICES DIVISION
APPLICATION - PHYTOSANITARY FIELD INSPECTION OF SEED CROP FOR EXPORT
APPLICANT NAME ADDRESS
CITY STATE ZIP PHONE
CONTACT NAME E-MAIL
APPL. NO. CROP VARIETY ACRES
STOCK LOT NO. HARVEST LOT NO.
GROWER NAME COUNTY
LOCATION (PLEASE INCLUDE A DETAILED MAP)
APPLICATIONS ARE DUE WITHIN 15 DAYS OF PLANTING
APPROXIMATE PLANTING DATE APPROXIMATE HARVEST DATE
RECEIVING COUNTRY(S) - LIMIT OF 7 ADDITIONAL PESTS/DISEASES OF CONCERN
ADDITIONAL PESTS/DISEASES INCLUDED IN
ATTACHED ADDENDUM
BY SIGNING BELOW YOU ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED IN THIS APPLICATION. THE DEPARTMENT
MAY REFUSE THIS APPLICATION FOR INACCURATE OR INCOMPLETE INFORMATION. INSPECTION FEES VARY AND ARE BASED
ON CROP AND ACREAGE. FOR A CURRENT FEE SCHEDULE PLEASE CONTACT THE NUMBER AT THE BOTTOM OF THE PAGE. BY
SIGNING YOU AGREE TO CHARGES INVOICED BY THE DEPARTMENT. PLEASE DO NOT SEND PAYMENT UNTIL INVOICED. ONCE
THE APPLICANT INFORMATION IS COMPLETE, PLEASE EMAIL OR PRINT AND MAIL THE APPLICATION, A DETAILED MAP OF THE
FIELD LOCATION AND ANY ADDITIONAL INFORMATION TO THE ARIZONA DEPARTMENT OF AGRICULTURE, PLANT SERVICES
DIVISION, 1688 W. ADAMS ST., PHOENIX AZ 85007.
APPLICANT'S REPRESENTATIVE
REPRESENTATIVE'S SIGNATURE DATE
https:/agriculture.az.gov
ARIZONA DEPARTMENT OF AGRICULTURE - PLANT SERVICES DIVISION - 1688 W. ADAMS ST. - PHOENIX, AZ 85007 - (602) 542-0992
ADA PSD 4/8/2019 MVK1
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ARIZONA DEPARTMENT OF AGRICULTURE - PLANT SERVICES DIVISION (Arizona)

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Completed 20 July 2020

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