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Kern County Department of Agriculture and Measurement Standards

County of Kern
Agriculture and Measurement Standards
Forms
Stack of Paper
Forms and Documents
All available forms and documents are arranged by Division and, except where noted, stored in Adobe pdf format. View pdf documents with Adobe Acrobat Reader. If your document is not listed please call (661)868-6300 or e-mail the Division Deputy to request a copy.

CONSUMER and AGRICULTURAL PROTECTION

Forms and Documents

Contact Deputy Director Nancy Holland at: hollandn@co.kern.ca.us
PHYTOSANITARY CERTS
 
CANADA ORIGIN
CERTIFICATE
Canadian Food Inspection Agency Certificate of Origin for counties NOT regulated for LBAM (includes Kern County).
 
CDFA QUARANTINE
COMPLIANCE CERT.
Certificate of origin and treatment (if applicable) for commodities shipped from or through Kern County.
 
FEDERAL PHYTO -
ATTACHMENT FORM
Official Federal Phytosanitary Certificate Attachment Sheet (Form PPQ 575).
 
FEDERAL PHYTO -
MS EXCEL TEMPLATE
Microsoft Excel template for completing Federal Phytosanitary Certificates (Form PPQ 577).
 
FEDERAL PHYTO -
SUPERCEDE FORM
Request to replace a previously issued Federal Phytosanitary Certificate.
 
PCIT
 
PCIT FACT SHEET
USDA Phytosanitary Certificate Issuance and Tracking (PCIT) System – Industry Fact Sheet.
 
USDA ADMIN FEE
 
CHECKS COLLECTED
WORKSHEET
Log for tracking the USDA Administrative Fee remitted in check form (for shippers using 4-part paper).
Corrected Address 11/24/09
 
KERN COUNTY MEMO
Kern County memo providing information on the USDA Administrative Fee collection process and exemptions for voided phytos.
 
PHYTOS ISSUED -
INSTRUCTIONS
Instructions for completing the USDA Administrative Fee worksheet.
 
PHYTOS ISSUED -
WORKSHEET
Log for tracking Date, Applicant, and Certificate Number for issued Federal Phytosanitary Certificates (for shippers using 4-part paper).
 
USDA MEMO
USDA Administrative Fee announcement and information.
 

 

ENVIRONMENTAL PROTECTION

Forms and Documents

Contact Deputy Director Glenn Fankhauser at: fankhauserg@co.kern.ca.us
APIARY
 
BEE MOVEMENT
Pin or unpin apiary locations for the Department's pesticide notification system.
 
BEE REGISTRATION
Beekeeper registration, apiary location(s), and request for pesticide notification.
 
PERMIT - CONDITIONS
 
ALDICARB
Aldicarb inventory, purchase history, recommendation records, and invoice requirements.
 
DRIFT MINIMIZATION
Aircraft and ground drift minimization measures for restricted materials.
 
GENERAL
Kern County 2010 General Permit Conditions (Effective January 1, 2010).
 
GWPA -
MANAGEMENT
Runoff and leaching management practices for Ground Water Protection Areas (GWPA). Includes pesticides subject to restriction and all classified Kern County GWP Areas (listed by TRS).
 
GWPA -
NON-PRODUCTION
Supplemental conditions for GWP Area materials when used at non-production and/or non-agricultural sites (non-site specific use).
 
METAM SODIUM/
POTASSIUM
Approved metam application methods, NOI requirements, and acceptable and prohibited times/locations. Includes the Kern County Fumigation Summary form.
 
PHENOXY
Allowed dates and restrictions for phenoxy applications.
 
TELONE
Overview, application methods, and background information for 1,3-Dichloropropene pesticides (fumigants).
 
THIODAN
Runoff containment and conditions for endosulfan aerial applications.
 
PERMIT - GENERAL
 
LETTER OF
AUTHORIZATION
Authorization for anyone other than the permittee (the operator of the property, defined as the owner, partner or officer of the business applying for the permit) to sign the permit.
 
PERMIT SUPPLEMENT
Application for a Restricted Materials Permit supplement.
 
RESPIRATORY PROGRAM -
PROCEDURES
Respirator selection, fit testing, training and evaluation for an organization's Written Work-Site Specific Procedures.
 
RESPIRATORY PROGRAM -
TRAINING FORM
Employee respirator assignment, fit test, training record, and consultation (Written Respiratory Protection Program - Attachment #1).
 
MISCELLANEOUS
 
INFORMATION REQUEST
Environmental and Public Protection Division information request. Use for Restricted Materials Permit and use report data requests. Note: Permit and use report data may be directly downloaded from our website.
 
NOI PILOT PROJECT
CONTACT PREFERENCES
Kern County grower contact phone and e-mail preferences for the Department's Notice of Intent Pilot Project to Protect Agricultural Workers.
 
PERMIT ACCESS
Instructions for downloading and viewing 1994 through current Restricted Materials Permit data.
 
PUR DATA ACCESS
Instructions for downloading and viewing 1994 through current Pesticide Use Report (PUR) data.
 
 

 

WEIGHTS AND MEASURES

Forms and Documents

Contact Deputy Director Manuel Villicaña at: villicam@co.kern.ca.us
GENERAL
 
COMPLAINT FORM
Division form for reporting a business in violation of weights and measures standards.
 
DEVICES
 
CALIFORNIA TYPE EVALUATION PROGRAM
Application for evaluation of a new Weighing or Measuring Device(s).
 
PLACED IN SERVICE
REPORT
Sample form for reporting placement after repair of a Commercial Weighing or Measuring Device.
 
SERVICE AGENCY APPLICATION
CDFA form for agencies registering to service Weights and Measures devices.
 
SERVICE AGENCY CANCELLATION FORM
CDFA form for agencies canceling their registration to service Weights and Measures devices.
 
MISCELLANEOUS
 
CONSUMER BROCHURE
CDFA Department of Measurement Standards consumer information brochure. Includes tips for the consumer and contact information.
 
WEIGHMASTER
 
COMMON TARE NOTICE
Notice of official tare and referenced weighmaster certificate number for posting at all weighing locations. Includes instructions.
 
WEIGHMASTER
LICENSING
Application for a new, renewal or updated Weighmaster License. Includes instructions.
 
WEIGHMASTER
LICENSE CANCELLATION
Form for canceling a Weighmaster License.
 
 

 



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12/10/2009
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