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United States 

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460 

Application for Registration of Pesticide-Producing and Device-Producing Establishment

Office of Enforcement and Compliance Assurance

Section 7, Federal Insecticide, Fungicide and Rodenticide Act (7 U.S.C. sec. 136e)

http://www2.epa.gov/compliance/pesticide-establishment-registration-and-reporting

OMB  Control No. 2070-0078

Expires on 3/31/2016 

EPA Form 3540-8 (Rev. 1/15) Previous versions are obsolete.

Page  of 

For EPA Use Only

Reviewer

EPA Region

Review Date

Postmark Date

Company Information

Authorized Agent (if applicable)

Signature of Company Official or Authorized Agent

Name and Site Address of Each Producing Establishment You are Registering

EPA Est. No.

(For EPA Use Only)

EPA/OECA/OC/MAMAPD

2012 Pesticide Establishment Registration Form

Form to register pesticide-producing establishments with EPA

2015

getinstructions: CurrentPage: PageCount: Press enter to add an additional page to enter additional establishments: Press enter to remove extra pages : print: ResetButton1: CoName: CoNumber: DBA: co.site.address: co.site.city: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: CoSiteProvince: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: CoSiteZipcode: CoMai.Address: CoMai.City: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: CoMailProvince: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: CoMailzipcode: phone: email: agent: AgentName: AgentAddress: AgentCity: AgentState: AgentZip: AgentPhone: AgenteMail: OffName: OffTitle: OffSign: Date: estabname2: EstabSiteAdd: Estab.site.city: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: EstabSiteProvince: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: EstabSiteZipcode: Estab.Mail.Address: EstabMailCity: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: EstabMailProvince: Please select your state or country abbreviation. Abbreviations are in alphabetical order with states listed first.: EstabMailZipcode: EstabPhone: EstabMailemail: