Restricted Use Pesticide Dealer Sales Record

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RESTRICTED USE PESTICIDE DEALER SALES RECORD
Page _____
Dealer Business Name ___________________________ License No. __________________ Responsible Person's Name _____________________
Licensed Applicator's
License No. &
Applicator's
Quantity and Unit
Date of Sale
Name
Expiration
NM County
Brand Name of Pesticide
EPA Reg. No.
(gal, lb, etc.)
It is against the law for a pesticide dealer to knowingly sell any restricted-use pesticide to any person who is not a licensed, certified applicator
(21.17.50.17 NMAC). Visit or telephone 575-646-2134 for more information.

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