Fillable SRPMIC Agricultural Notification - Arizona Form 1080 Salt (Salt River Pima-Maricopa Indian Community)

Fill Online, Printable, Fillable, Blank SRPMIC Agricultural Notification - Arizona Form 1080 Salt (Salt River Pima-Maricopa Indian Community) Form

Use Fill to complete blank online SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY (AZ) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

SRPMIC Agricultural Notification - Arizona Form 1080 Salt (Salt River Pima-Maricopa Indian Community)

On average this form takes 33 minutes to complete

The SRPMIC Agricultural Notification - Arizona Form 1080 Salt (Salt River Pima-Maricopa Indian Community) form is 1 page long and contains:

  • 2 signatures
  • 12 check-boxes
  • 117 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Salt River Pima-Maricopa Indian Community

BROWSE SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY (AZ) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Harvest Label and Worker Safety Reentry Interval Label Days Pesticide Application
Date to Harvest Date
Crop Section Township Range Acres Section Township Range Acres
Rate & Unit Dilution/ Total
of Measure/Acre 100 GAL Chemical
Total Total Volume Supplemental Label Required
Acres Per Acre
SRO 60-79, Section 13.109.4 (A)(1) -- PESTICIDE POST-APPLICATION REPORT
Other: _________________________ Yes No
Custom Applicator ______________________________________________________ Delivery Location ____________________________________________
Label Restrictions/Special Instructions __________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Office Use Only
Product/Brand Name
EPA Registration Numberr
Grower ___________________________________________________
Seller _____________________________________________________
Additional Field Descriptions ________________________________________________________________________________________________________
I, the undersigned, certify that an application of pesticides was made by the designated applicator in strict compliance with the above recommendation and
instructions on the date and under the conditions specified below.
Deviation From Instructions ___________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Grower/Pesticide Advisor's Signature __________________________________________________________ PGP/PCA Number_______________________
AAP # __________________________
THIS DOCUMENT MUST BE SUBMITTED TO THE SRPMIC-EPNR PESTICIDE OFFICE WITHIN 48-HOURS PRIOR TO THE APPLICATION.
Company Name ____________________________________________________________________________________PGP/CA # _______________________
Grower/Applicator Signature __________________________________________________________________________ PUP/PUC # ______________________
Copy Distribution: Two Copies to Applicator -- One Copy to Advisor -- One Copy to Seller -- One Copy to Grower --One Copy to SRPMIC-EPNR
Crop
I, the undersigned, certify that the above instructions comply with SRO 60-79, Section 13-55 and SRO 60-79, Section 13.109.4 (A)(2).
Equipment Tag # Time(s) of Application Date(s) AppliedWind Direction & Velocity
_________________________________________________________________________________________________________________________________
Print Operator(s)/Pilot Name __________________________________________________________________________
Salt River
Environmental Protection & Natural Resources
_________________________________________________________________________________________________________________________________
PMA Area Yes No
Date ___________________________
County _________________________
PSP # _________________________________
PGP # _________________________________
SRPMIC Agricultural Notification - Arizona Form 1080
10005 East Osborn Road, Scottsdale AZ 85256
Phone (480) 362-7500 E-mail: pesticides@srpmic-nsn.gov Fax (480) 362-7584
Ground Water BMP Yes No
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Pest Conditions
Yes No
AZDEQ Soil Applied
Active Ingredient
Air Ground Chemigation
Pima-Maricopa Indian Community
Print Form
Submit by E-mail
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

SRPMIC Agricultural Notification - Arizona Form 1080 Salt (Salt River Pima-Maricopa Indian Community)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document