Fertilizer Registration Form
Transcription
Fertilizer Registration Form
DEPARTMENT OF PLANT INDUSTRY 511 WESTINGHOUSE ROAD PENDLETON, SC 29670 864-646-2140 Fertilizer Registration Form (Registration Year: July 1st – June 30th) Instructions: Please indicate your name and mailing address in the space below as it appears on your product label. Determine your license fee from the Fee table and include payment with this form. Checks should be made payable to Clemson University. All registrants must obtain license whether registering bulk, specialty, or both. For specialty fertilizer, please submit a product label for each product. Include nitrogen source for each product using the following codes: U = Urea, AS = Ammonium Sulfate, AM = Ammonium Nitrate, OS = All other sources. If all bulk products use the same source, you need not list each brand. For products containing waste materials and/or industrial by-products, please provide the appropriate information*. You are required to submit any changes to this information as soon as they occur. Questions you may have in completing this form may be directed to 864-646-2140. Company Name__________________________________________________________________________________ Address __________________________________________________________Phone ( )___________________ ________________________________________________________________________________________ Contact Person _________________________E-Mail_________________________Date _______________________ PLEASE ANSWER ALL OF THE QUESTIONS BELOW. FAILURE TO DO SO WILL RESULT IN A DELAY IN PROCESSING. Does the business represented by this application for registration intend to sell any of the following products in South Carolina? You must answer all of the following items: 1) Ammonium Nitrate Yes No 2) Urea Yes No 3) Anhydrous Ammonia Yes No *Do any of the products requested for registration contain waste materials or industrial by-products? Yes_____ No_____ If yes, please provide: (1) a description of the waste materials and/or industrial by-products; and (2) a detailed description of the process that generates the waste and any by-products. Please provide any other analytical data that may be available for these processes. If biosolids are used, submit documentation that the biosolids meet the federal 40 CFR 503 requirements for classification as a Class “A-EQ” biosolid. The confidentiality of all information submitted will be maintained. Please provide the appropriate information as an attached document. Product Name (Include EPA Reg. # for products containing pesticides) FEE TABLE Tonnage Volume (from previous year) 0 – 5,000 5,000 – 25,000 25,000 or greater Specialty Fertilizer (sold in packages 10 lbs. or less) AMOUNT PAID: $ Package Weight Specialty (S) or Bulk (B) Nitrogen Source For Office Use Only: License Fee $100 / year $200 / year $400 / year $60 / product per year + license fee Date approved:__________________ By:___________________________________ Expiration Date:____________________