Frost Protection Negative Declaration Form
Download a blank fillable Frost Protection Negative Declaration Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Frost Protection Negative Declaration Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1DEPARTMENT OF AGRICULTURE/WEIGHTS & MEASURES
133 Aviation Boulevard, Suite 110
Tony Linegar
Santa Rosa, CA 95403-1077
Agricultural Commissioner
(707) 565-2371
Fax (707) 565-3850
Sealer of Weights and Measures
VINEYARD & ORCHARD
OFFICE USE ONLY
(04/14/2015)
FROST PROTECTION NEGATIVE DECLARATION
Date Surveyed:
/
/
Surveyed By:
Fill out one form for each site located within the Russian River Watershed that does NOT
use water for frost protection. Form must be signed by property owner or authorized
representative.
Site Address:
Prior Reg #
: AFM
–
(if applicable)
Check one:
☐
☐
Vineyard
Orchard
PROPERTY OWNER:
DBA
:
MAILING ADDRESS:
CITY:
STATE
:
ZIP
:
PHONE
:
FAX:
CELL
:
EMAIL
:
AUTHORIZED REPRESENTATIVE (if different than owner above):
COMPANY:
MAILING ADDRESS:
CITY:
S
TATE:
Z
IP
:
PHO
NE:
FAX:
CELL:
EMAIL
:
SITE ADDRESS:
ASSESSOR’S PARCEL NUMBER(S)
:
CORRESPONDING PESTICIDE PERMIT SITE ID #(S
):
FROST PROTECTION
☐
No frost protection system.
(check the statement that best applies):
☐ Fr
ost protection system does not use water – fans, etc.
I CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT AND VALID TO THE BEST OF MY KNOWLEDGE.
Print Name:
Date:
: ☐ wner
☐
Signature:
Check one
O
Authorized Representative
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business