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OPERATOR IDENTIFICATION NUMBER APPLICATION
For new applicants only, do not use to renew an existing or expired permit. Must be completed prior to booking an appointment.
Name
*
First and Last
DBA (if applicable)
Phone
*
Phone number with area code.
Format: (000) 000-0000.
Email
*
Confirmation Email
Confirm email is correct by typing a second time.
Mailing Address
*
Include street and city
Physical Address
*
Include street and city
Pests to be controlled – check all that apply
*
Terrestrial weeds
Insects/Mites
Aquatic weeds/pests
Disease/Mildew
Vertebrates
Other
Commodities to be Treated: If you don't have that commodity, enter zero.
*
Rows
Acres
Brush Control on Personal Property (Uncultivated, non-ag)
Pond or ditch
Grape
Vegetables (can list along with acreage)
Stone Fruit (peach, plum, nectarine, cherry, pluot)
Pome Fruit (apple, pear, quince)
Pasture (irrigated)
Rangeland (non-irrigated)
Timber (only for active forest management)
Cannabis
Other (can input along with acreage)
Who will be applying pesticides?
*
Myself
Employees
Licensed Pest Control Businesses
Other
Are you the property operator?
*
I am the landowner of the above identified property, or legal operator of the property. “Operator of the property” means a person who owns the property and/or is legally entitled to possess or use theproperty through terms of a lease, rental contract, trust, or other management arrangement.
I am not the property operator, and I understand I will need to complete the Letter of Authorization form, have both parties sign, and upload the file either now, or provide it to us prior to the issuance of a pesticide permit.
If you need the Letter of Authorization, you can download that here.
Letter of Authorization
File Upload For Letter of Authorization
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature
*
Title
Ex. owner or manager
Date
*
/
Month
/
Day
Year
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