Get Pesticide Analysis Report - California Department Of ...

This guide provides a comprehensive overview of how to properly fill out the pesticide analysis report required by the California Department of Pesticide Regulation. By following these instructions, users will ensure that all necessary information is accurately recorded in the online form.

Follow the steps to fill out the pesticide analysis report online

1. Click ‘Get Form’ button to obtain the pesticide analysis report and open it in your preferred online document editor.
2. In Section A, Registration/Product Information, input the laboratory number, product brand name (as labeled), state/EPA registration number, registered product brand name, and EPA establishment number. Also, enter the date when the sample was taken, registrant/manufacturer details, EPA firm number, sample number, lot number, and label identification/invoice number. Specify the quantity and container size.
3. In Section B, Possessor Information, fill in the possessor/seller/business name and include a telephone number with area code. Enter the date the possessor received the lot, along with the street address, city/state, and ZIP code. Also, indicate where the lot was received from, providing the city/state and ZIP code.
4. Section C requires you to check the appropriate box for the signal word: danger, warning, caution, or no signal word. Additionally, list the guarantee percentage and label claim/active ingredients. Provide any relevant comments in this section.
5. In Section D, Certification, acknowledge that the sample collection adheres to the prescribed laws by providing the name of the person acknowledging the sample collection.
6. For Section E, Formulations Laboratory Remarks, specify the methods used along with the names of the first and second chemists. Document the analysis disposition dates and any additional remarks.
7. In Section F, Decision, record the chemist's decision and ensure that the chemist signs the report. Complete any necessary information on the reverse side of the form.
8. In Section G, Sample Information, detail the sample collector's name, EPA registration number, and sample number. Indicate the container description and preservation method during transport.
9. In Section H, Transportation Information, include the destination, vehicle driver/common carrier details, license number/shipping invoice number, DOT number/classification, and the date the sample was shipped. Confirm that the sample is properly classified and certified for transport.
10. Section I relates to Chain of Custody; document who received and delivered the sample through its various handlers, including dates, times, and purposes.
11. Finally, in Section J, Laboratory Storage, record the name of the person who received the sample, the date, time, and storage location.
12. Conclude by saving changes, downloading the completed form, printing a copy, or sharing it as needed.

Begin filling out the pesticide analysis report online today to ensure compliance and accurate data submission.