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County Agricultural Commissioner forms used for inspections, violation notices and other county enforcement activities

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California Fumigant Management Plan (FMP) templates

Form Number Form Description
DPR-ENF-220, PDF (458 kb) (New 12-10) Fumigant Management Plan (Field Fumigation)
DPR-ENF-221, PDF (353 kb) (New 12-10) Authorized On-Site Personnel (Field Fumigation)
DPR-ENF-222, PDF (341 kb) (New 12-10) Air Monitoring (Field Fumigation)
DPR-ENF-223, PDF (387 kb) (New 12-10) Monitoring During Application (Field Fumigation)
DPR-ENF-224, PDF (401 kb) (New 12-10) Monitoring Post-Application (Field Fumigation)
DPR-ENF-225, PDF (309 kb) (New 12-10) Post-Application Water Treatments (Field Fumigation)
DPR-ENF-226, PDF (388 kb) (New 12-10) Post-Application Summary (Field Fumigation)

Inspection forms used by County Agricultural Commissioners

Form Number Form Description
PR-ENF-101, PDF (389 kb) (Rev. 01/10)
 Violation Notice
PR-ENF-102, PDF (240 kb) (Rev. 01/10)
 Pesticide Pre-Application Site Evaluation
PR-ENF-103, PDF (332 kb) (Rev. 01/10)
 Field Worker Safety Inspection Report
PR-ENF-104, PDF (514 kb) (Rev. 01/10)
 Pesticide Use Monitoring Inspection Report
PR-ENF-105, PDF (366 kb) (Rev. 01/10)
 Commodity Fumigation Use Monitoring Inspection Report
PR-ENF-106, PDF (416 kb) (Rev. 01/10)
Field Fumigation Use Monitoring Inspection Report
PR-ENF-107, PDF (424 kb) (Rev. 01/10)
 Structural Fumigation Use Monitoring Inspection Report
PR-ENF-108, PDF (432 kb) (Rev. 01/10)
 Structural Use Monitoring Inspection Report
PR-ENF-109, PDF (558 kb) (Rev. 01/10)
 Pest Control Headquarters Inspection Report
PR-ENF-110, PDF (483 kb) (Rev. 01/10)
 Pest Control Business Headquarters Inspection Report
PR-ENF-111, PDF (201 kb) (Rev. 01/10)
 Inspection Report / Violation Notice Supplement


For content questions contact:
Jim Walsh
1001 I Street, P.O. Box 4015
Sacramento, CA 95812-4015
E-mail: jwalsh@cdpr.ca.gov

Additional forms used by County Agricultural Commissioners

Form Number Form Description
DPR-071, PDF (78 kb) (Est. 07/05) Clothing Release Form/Formulario para Entregar la Ropa
DPR-161, PDF (449 kb) (Rev. 08/07) Decision Report
DPR-161A, PDF (531 kb) (Est. 08/07) Decision Report Supplement
DPR-197, PDF (34 kb) (Rev. 05/12) Forms Requisition
PR-ENF-002, PDF (472 kb) (Rev. 09/10) Produce Sample Analysis Report
PR-ENF-008, PDF (415 kb) (Est. 09/94) Report of Loss, Nonperformance or Damage
PR-ENF-016, PDF (433 kb) (Est. 09/09) Operator Identification Number Application
PR-ENF-017A, PDF (189 kb) (Rev. 08/08) Production Agriculture Monthly Pesticide Use Report
PR-ENF-017B, PDF (168 kb) (Rev. 08/08) Production Agriculture Monthly Pesticide Use Report Supplement

PR-ENF-030, PDF (125 kb) (Rev. 08/09) Investigative Sample Analysis Report
PR-ENF-046, PDF (63 kb) (Rev. 06/01) Enforcement/Compliance Action Summary (Instructions and Procedures)

DPR-ENF-072, PDF (37 kb) (Rev. 02/11) Enforcement and Compliance Options Chart
PR-ENF-074, PDF (120 kb) (Est. 09/94) Complaint of Human Exposure or Unsafe Condition
DPR-ENF-086, PDF (38 kb)(Rev. 05/12) Preparing for Your Administrative Pesticide Penalty Hearing
PR-ENF-097, PDF (307 kb) (Rev. 06/07) Pesticide Illness Investigation Request for Time Extension

PR-ENF-099, PDF (204 kb) (Rev. 03/03) Pesticide Regulatory Activities Monthly Report
PR-ENF-100A, PDF (21 kb) (Est. 03/94) Statement
PR-ENF-100B, PDF (19 kb) (Est. 03/94) Statement Continuation
PR-ENF-125, PDF (446 kb) (Rev. 11/07) Application - Restricted Materials Permit
PR-ENF-125A, PDF (578 kb) (Rev. 10/07) Application - Restricted Materials Permit - Supplemental
PR-ENF-126, PDF (442 kb) (Rev. 11/07) Notice of Intent to Apply Restricted Materials
PR-ENF-127, PDF (552 kb) (Rev. 08/07) Pesticide Episode Investigation Report
PR-ENF-127A, PDF (430 kb) (Rev. 08/07) Pesticide Episode Investigation Supplemental Report
PR-ENF-127B, PDF (528 kb) (Rev. 08/07) Episode Witness/Injured/Complainant Report
PR-ENF-127C, PDF (602 kb) (Rev. 08/07) Episode Site Diagram
PR-ENF-127D, PDF (694 kb) (Rev. 08/07) Field Worker Dermatitis Supplemental Report
PR-ENF-133, PDF (20 kb) (Rev. 02/04) Medical Information Authorization
PR-ENF-133X, PDF (22 kb)(Rev. 02/04) Autorización de Información Médica
PR-ENF-149, PDF (115 kb) (Rev. 05/04) Pesticide Statutes Violation Notice
DPR-ENF-162, PDF (31 kb) (Rev. 02/11)
 Summary of Pesticide Use Regulatory Authorities
PR-ENF-182, PDF (162 kb) (Est. 10/91) Antimicrobial Exposure Episode Report
PR-ENF-199, PDF (671 kb) (Rev. 05/04) Pesticide Analysis Report
PR-ENF-211, PDF (158 kb) (Rev. 04/03) Complaint Referral
PR-ENF-212, PDF (94 kb) (Rev. 04/03) Complaint Referral - Supplemental
PR-PML-045, PDF (20 kb) (Rev. 12/06) Private Applicator Certificate Application
Pesticide use reporting forms