Fillable DestructionReport StateofConnecticut Applications, supporting documents and payments will (State of Connecticut/Department of Administrative Services)

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DestructionReport StateofConnecticut Applications, supporting documents and payments will (State of Connecticut/Department of Administrative Services)

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StateofConnecticut
DepartmentofAgriculture
BureauofRegulatoryServices
450ColumbusBlvd,Suite702Hartford,CT06103
Phone:860‐713‐2502 Email:AGR.Hemp@ct.gov
DestructionReport
(rev.6/26/19)
Applications, supporting documents and payments will only be accepted
through the DOAG E-License portal. Paper applications will not be accepted.
Thisformisdueforeveryplot(indoororoutdoor).Thisreportisduewithin15dayspriortodestruction.No
destructionisauthorizeduntilyoureceiveapprovalinwritingfromtheDepartment.Note:Aninspectorfromthe
Departmentmaybepresentatthegrowingsiteduringthegrower’sscheduledhempcropdestruction.
LicenseHolder: GrowerLicense#:
NameofSigningAuthority(ifBusiness):
Email: Phone#:
Ifyo
uintendtodestroythehempcrop,completetheinformationinthetablebelow.Youmustreceive
approvalfromtheDepartmentofAgriculturepriortodestruction.TheGrowerPlotIDbelowMUST
correspondtothelicensedPlotIDonyourapplicationorsitemodificationrequest.
DOAG
assignedPlot
ID
Grower
PlotID
Hemp
Variety/
Strain
Acres/sq.ft
proposedfor
destruction
Dateof
Proposed
Destruction
ReasonforProposed
Destruction
Willtherebeanysalvageof
thehempcrop?(Y/N)
Hemp18 5acres 8/1/2019 Weedpressure Yes
2. Describe
theplannedmethodofdestructionandattachadditionaldocumentationifnecessary.
Print
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
3.Describetheproposedmethodofsalvageandhowyouintendtousethesalvagedmaterials.
Bysigningmynamebelow,IattestthatIamthelicenseholderorthesigningauthorityofthelicense
holder,andthatthisinformationisaccurateandcomplete.Iunderstandthatgivingafalsestatement
ispunishablebylawundersection53a‐157boftheConnecticutGeneralStatutes.
Signature:_________________________________________________Date:_____________________
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Completed 20 July 2020

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