Form 1070 - Application For Registration Of Agricultural Liming Material

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Form 1070 (Rev, 4-14)
APPLICATION FOR REGISTRATION OF AGRICULTURAL LIMING MATERIAL
For fiscal year ending June 30, 20___
Instruction:
Submit in duplicate
to the Arkansas Plant Board, P.O. Box 1069, Little Rock, AR 72203. One copy
th
will be returned to the registrant upon approval. All registrations expire June 30
of each year.
To the Plant Board: Registration for sale and/or distribution in Arkansas of the agricultural liming
materials described below is hereby requested:
GUARANTEED ANALYSIS
Neutralizing
Fineness
Value
Min % Calcium
Min %
Min %
Min % Passing
Name of Product
Carbonate
Passing 60
Passing 100
10 Mesh
Equivalent
Mesh
Mesh
REGISTRATION FEE is $15.00 per liming material (make check payable to
The State Plant Board)………………………………………………………………………$_______________
I hereby certify the above description is true and correct and that every package and bulk load will be labeled as
above. The applicant agrees to make quarterly reports to the State Plant Board of the tonnage of liming materials
sold and/or distributed in Arkansas and to pay the inspection fee of $ .30 per ton, such reports to be sent to the Plant
Board not later than 30 days after the end of each quarter as provided in Section 4 of Act 353 of 1969, as amended
by Act 724 of 1983. Applicant further agrees to keep such records as to accurately indicate the tonnage of liming
materials sold in Arkansas and permit the State Plant Board or its duly authorized agent to examine such records in
order to verify the statement of tonnage.
REGISTRATION #:
CHECK ONE:
New Company /Product
Renewal
FIRM NAME___________________________________________________________
_______________________
Address: _____________________________
City & State __________Zip ________
Not
DO NOT WRITE ON THIS SPACE
_
__________________________________________________
Approved for the year ending
Print Name & Title
June 30, 20______
Date______________
Phone________________
________________________________
Jamey Johnson, Director
Feed & Fertilizer Division
_______________________
Date
_______________________

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