Pesticide Management Division Forms
For more information on Agricultural Environmental Services Division forms, call toll-free 877-301-4555.
Pesticide Compliance Forms
| Form Name | Form Number |
|---|---|
| Pesticide Sensitive Individual Application and Renewal Form [PDF] | AGR 4112 |
| Pesticide Application Record - Verion 1 (English) [PDF] | AGR-4226 |
| Pesticide Application Record - Verion 2 (English) [PDF] | AGR-4235 |
| Pesticide Application Record - Verion 3 (English) [PDF] | AGR-4236 |
| Pesticide Application Record - Verion 4 (English) [PDF] | AGR-4234 |
| Pesticide Application Record - Verion 5 (English) [PDF] | AGR-4237 |
| Pesticide Application Permit Request [PDF] | AGR 4115 |
| Checklist for the Worker Protection Standard - Outdoor Production [PDF] | AGR-4153 |
Technical Services and Education Forms
| Form Name | Form Number |
|---|---|
| Worker Protection Standard Training Verification Card Request - Trainer Agreement [PDF] | AGR-4154 |
| Worker Protection Standard (WPS) - Pesticide Safety Training Record [PDF] | AGR-4155 |
| Worker Protection Standard (WPS) - Training Verification Record [PDF] | AGR-4159 |
| Worker Protection Standard Training Verification Card Program - Statement of Lost of Stolen Card [PDF] | AGR-4158 |
Pesticide Registration Forms
| Form Name | Form Number |
|---|---|
| Application for Registration of Pesticides | AGR-4216 |
| Application for Permit - Experimental Use Pesticides on Aquatic Sites | AGR-4128 |
| Aquatic Risk Assessment | AGR 630-4129 |
| Collective Experimental Use Permit | AGR 630-4130 |
| Section 25(b) Confidential Statement of Formula | AGR 707-4139 |
| Spray Adjuvant Confidential Statement of Formula | AGR 707-4325 |
| Washington State Experimental Use Permit (WSEUP) | AGR 630-4257 |
Fertilizer Registration and Tonnage Forms
| Form Name | Form Number |
|---|---|
| Application for Registration of Commercial Fertilizer [PDF] | AGR-4300A |
| Commercial Fertilizer Inspection Fee Liability Statement [PDF] | AGR 4303 |
| Commercial Fertilizer New Product Registration [PDF] | AGR-4300B |
| Semi-Annual Commercial Fertilizer Tonnage Report [PDF] | AGR-4302 |
| Annual Commercial Fertilizer Tonnage Report [PDF] | AGR-4330 |
| Waste Derived/Micronutrient Fertilizer Registration Dept of Ecology Questionnaire [PDF] | N/A |
Pesticide/SPI Licensing and Recertification Forms
| Licensing - Form Name | Form Number |
|---|---|
| Commercial Applicator Company Application [PDF] | AGR-4241 |
| Commercial Applicator Company Application (Spanish) [PDF] | AGR-4241-spa |
| Commercial Applicator Renewal Application [PDF] | AGR-4219 |
| Commercial Applicator Renewal Application (Spanish) [PDF] | AGR-4219-spa |
| License Review Request [PDF] | AGR-4181 |
| Pesticide/Pest Inspector License Application [PDF] | AGR-4223 |
| Pesticide/Pest Inspector License Application (Spanish) [PDF] | AGR-4223S |
| Pesticide/SPI License Renewal Application [PDF] | AGR-4280A |
| Pesticide/SPI License Renewal Application (Spanish) [PDF] | AGR-4280A-spa |
| Limited and Rancher Private Applicator Renewal Application [PDF] | AGR-4380 |
| Reciprocal Pesticide Licensing Request [PDF] | AGR 702-4176 |
| SPI Company License Application [PDF] | AGR 640-4175 |
| Supplemental Commercial Applicator Pesticide License Application [PDF] | AGR 702-4242 |
| WSU Testing Supplies Order Form [PDF] | N/A |
| Commercial Applicator Pesticide License Affidavit of Management Responsibility [PDF] | AGR-4383 |
| Financial Responsibility - Form Name | Form Number |
|---|---|
| Commercial Applicator Financial Responsibility Insurance Certificate (FRIC) [PDF] | AGR-4279 |
| Commercial Applicator Surety Bond Form [PDF] | AGR-4879 |
| SPI Assigned Account - Option 4 [PDF] | AGR 640-4187 |
| SPI Financial Responsibility Insurance Certificate - Option 1 [PDF] | AGR 640-4179 |
| SPI Financial Responsibility Insurance Certificate - Option 3 [PDF] | AGR 640-4189 |
| SPI Bond Form - Options 2 & 3 [PDF] | AGR 640-4177 |
| Recertification - Form Name | Form Number |
|---|---|
| Request for Recertification Course Accreditation [PDF] | AGR-4286 |
| Recertification Course Accreditation - Detailed Agenda and Presentation Summary [PDF] | AGR-4366 |
| WSDA Recertification Course Audit Form [PDF] | N/A |