I am a certified applicator authorized by the scope of my _________________________ (license/certificate type) license/certification No. __________ issued by __________ to use the restricted material(s) I am purchasing.
My certificate/license is valid until _____________________________________________ (Date).
My category(ies) relevant to this pesticide's intended use are: ____________________
Name of the business, agency, or operator of the property that I am employed by (if applicable): _______________
_____________________ | ______________________ | |
(Certified Applicator) | (Date) |
Cal. Code Regs. Tit. 3, § 6568
Note: Authority cited: Sections 11456 and 14005, Food and Agricultural Code. Reference: Sections 11501, 14006, 14010 and 14035, Food and Agricultural Code.
2. Amendment filed 1-4-89; operative 1-4-89 pursuant to Government Code section 11346.2(d) (Register 89, No. 5).
3. Amendment filed 12-22-89; operative 1-1-90 (Register 90, No. 1).
4. Editorial correction of printing errors in form (Register 91, No. 33).
5. Change without regulatory effect amending subsection (b) and Note filed 8-27-96 pursuant to section 100, title 1, California Code of Regulations (Register 96, No. 35).
6. Amendment of section and Note filed 10-20-2000; operative 11-19-2000 (Register 2000, No. 42).
7. Change without regulatory effect amending subsection (b) filed 5-15-2023 pursuant to section 100, title 1, California Code of Regulations (Register 2023, No. 20).
8. Amendment of subsections (b) and (c) filed 6-30-2023; operative 1/1/2024 (Register 2023, No. 26).