County Agricultural Commissioner forms used for inspections, violation notices and other county enforcement activities
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California Fumigant Management Plan (FMP) templates
Always comply with requirements specified on soil fumigant labeling. These templates are designed to help users meet the requirements that appear on Phase 2 labels of soil fumigants, which began to be distributed in December 2012. In contrast, labels on older fumigant products may require less information, or different information, on either the Fumigant Management Plan or Post-Application Summary.
| Form Number | Form Description |
|---|---|
| DPR-ENF-222, PDF (New 12/10) | Air Monitoring (Field Fumigation) |
| DPR-ENF-223, PDF (New 12/10) | Monitoring During Application (Field Fumigation) |
| DPR-ENF-224, PDF (New 12/10) | Monitoring Post-Application (Field Fumigation) |
| DPR-ENF-225, PDF (New 12/10) | Post-Application Water Treatments (Field Fumigation) |
| DPR-ENF-227, PDF (New 12/12) | Fumigant Management Plan (Field Fumigation) |
| DPR-ENF-228, PDF (New 12/12) | Post-Application Summary (Field Fumigation) |
Inspection forms used by County Agricultural Commissioners
| Form Number | Form Description |
|---|---|
| PR-ENF-101, PDF (Rev. 01/10) |
Violation Notice |
| PR-ENF-111, PDF (Rev. 01/10) |
Inspection Report / Violation Notice Supplement |
Additional forms used by County Agricultural Commissioners
| Form Number | Form Description |
|---|---|
| DPR-071, PDF (Est. 07/05) | Clothing Release Form/Formulario para Entregar la Ropa |
| DPR-161, PDF (Rev. 08/07) | Decision Report |
| DPR-161A, PDF (Est. 08/07) | Decision Report Supplement |
| DPR-197, PDF (Rev. 02/18) | Forms Requisition |
| DPR-ENF-002, PDF (Rev. 07/13) | Produce Sample Analysis Report |
| PR-ENF-008, PDF (Est. 09/94) | Report of Loss, Nonperformance or Damage |
| DPR-ENF-013A, PDF (Rev. 11/21) | California Restricted Materials Requirements |
| DPR-ENF-013A-SP, PDF (Rev. 11/21) | Requisitos Para Materiales Restringidos en California |
| DPR-ENF-013B, PDF (Rev. 10/13) | Ground Water Protection Materials |
| DPR-ENF-013C, PDF (Rev. 03/17) | Minimal Exposure Pesticides |
| PR-ENF-016, PDF (Est. 09/09) | Operator Identification Number Application |
| DPR-ENF-030, PDF (Rev. 03/21) | Investigative Sample Analysis Report |
| LIC-045, PDF (Rev. 07/23) | Private Applicator Certificate Application |
| DPR-ENF-046, PDF (Rev. 01/15) | Enforcement/Compliance Action Summary
(Instructions and Procedures) |
| DPR-ENF-055, PDF (Est. 03/14) | Pesticide Episode Closing Report |
| DPR-ENF-047, PDF (NEW 01/15) | Enforcement/Compliance Action Summary Supplemental
(Instructions and Procedures) |
| DPR-ENF-072, PDF (Rev. 01/23) | Enforcement and Compliance Options Chart |
| PR-ENF-074, PDF (Rev. 09/94) | Complaint of Human Exposure or Unsafe Condition |
| DPR-ENF-086, PDF (Rev. 04/23) | Preparing for Your Pesticide Administrative Civil Penalty Hearing |
| PR-ENF-097, PDF (Rev. 06/07) | Pesticide Illness Investigation Request for Time Extension |
| PR-ENF-100A, PDF (Est. 03/94) | Statement |
| PR-ENF-100B, PDF (Est. 03/94) | Statement Continuation |
| DPR-ENF-114, PDF (Est. 03/14) | Pesticide Episode Notification Record |
| DPR-ENF-115, PDF (Est. 03/14) | Pesticide Episode 15-Day Report |
| PR-ENF-125, PDF (Rev. 11/07) | Application - Restricted Materials Permit |
| PR-ENF-125A, PDF (Rev. 10/07) | Application - Restricted Materials Permit - Supplemental |
| PR-ENF-126, PDF (Rev. 11/07) | Notice of Intent to Apply Restricted Materials |
| PR-ENF-127, PDF (Rev. 08/07) | Pesticide Episode Investigation Report |
| PR-ENF-127A, PDF (Rev. 08/07) | Pesticide Episode Investigation Supplemental Report |
| PR-ENF-127B, PDF (Rev. 08/07) | Episode Witness/Injured/Complainant Report |
| PR-ENF-127C, PDF (Rev. 08/07) | Episode Site Diagram |
| PR-ENF-127D, PDF (Rev. 08/07) | Field Worker Dermatitis Supplemental Report |
| PR-ENF-128, PDF (Est. 12/03) | Pesticide Episode Investigation Non-Occupational Exposure Supplement |
| DPR-ENF-130, PDF (Est. 06/15) | Photo Mount |
| DPR-ENF-133, PDF (Rev. 07/13) | Medical Information Authorization |
| DPR-ENF-133X, PDF (Rev. 07/13) | Autorización de Información Médica |
|
DPR-ENF-162, PDF (Rev. 02/11) |
Summary of Pesticide Use Regulatory Authorities |
| PR-ENF-199, PDF (Rev. 05/04) | Pesticide Analysis Report |
| PR-ENF-211, PDF (Rev. 04/03) | Complaint Referral |
| PR-ENF-212, PDF (Rev. 04/03) | Complaint Referral - Supplemental |
| Pesticide use reporting forms |
For content questions, contact:
Erin Shibata
3077 Fite Circle, Suite 100
Sacramento, CA 95827
E-mail: Erin.Shibata@cdpr.ca.gov