Cal. Code Regs. tit. 3 § 6576
Prior to sale of a pesticide containing the active ingredient clopyralid for which use restrictions have been established in section 6950, the licensed pest control dealer shall obtain and retain for two years a signed statement from a licensed or certified qualified applicator in substantially the following form:
I, (print name of purchaser), certify that my employees or I will not apply any product containing clopyralid to a residential lawn, and will only apply clopyralid to sites where I can assure the collected grass clippings will remain on the property.
Name of Product:
___________________________
EPA Reg. No.:
______________________________
Under penalty of perjury, the foregoing statement is true and my employees or I will not apply any pesticide containing the active ingredient clopyralid for lawn and turf uses as defined in Food and Agricultural Code section 13190(e) except in accordance with the listed applicator responsibility requirements.
| ___________________________ | ___________________________ | |
| Signature of Qualified Applicator | License or Certificate No. | |
| ___________________________ | ___________________________ | ___________________________ |
| Category | Expiration Date | Date of Purchase |
Cal. Code Regs. Tit. 3, § 6576
Note: Authority cited: Sections 11456, 12111, 12781, 12976 and 14102, Food and Agricultural Code. Reference: Sections 12824, 13191 and 13192, Food and Agricultural Code.