Pest Control Business County Registration Form

ADVERTISEMENT

PEST CONTROL BUSINESS COUNTY REGISTRATION
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
PEST MANAGEMENT AND LICENSING BRANCH
REGISTRATION EXPIRATION DATE: DECEMBER 31, 2016
_____________________
______________________
FOR REGISTRATION IN COUNTY OF:
BUSINESS LOCATION
LIC. EFFECTIVE DATE
LIC. EXPIRATION DATE


RIVERSIDE
_____________________
______________________
MAIN
BRANCH
(QAL) PCO LICENSE NUMBER
CATEGORIES
BUSINESS NAME: ______________________________________________
NAME:__________________________________________________________________________________
______________________________________________
BUS. LIC. # ______________
________________________________________________
ADDRESS:
_____________________________________________________________________________________
ADDRESS: ______________________________________________________________________________________
CITY
STATE
ZIP CODE
PEST CONTROL CARD INFORMATION AREA
CITY: ________________________________________________ STATE: ___________ ZIP: ________________
(ATTACH COPY OF PEST CONTROL BUSINESS LICENSE)
BUS. PHONE # : _______________________________________
REGISTRATION FEE RECEIVED $ ____________
EMAIL ADDRESS: _____________________________________________________________________________
AGRICULTURAL COMMISSIONER
QUALIFIED APPLICATOR’S SIGNATURE: _____________________________________ DATE: ____________
COUNTY OF RIVERSIDE
4080 LEMON STREET, ROOM 19
CONDITION(S) ATTACHED
Restricted Material(s) Possession Permit No._________________________
PO BOX 1089


No Restricted Material may be possessed except in accordance with any
YES
NO
RIVERSIDE, CA 92502-1089
attached condition(s). This is not a permit to apply.
AGRICULTURAL COMMISSIONER’S SIGNATURE
DATE
IMPRINTING COUNTY’S OFFICIAL SEAL
*PLEASE FILL OUT BOTTOM PORTION AS WELL, AS IT WILL BE MAILED BACK TO YOU ATTACHED
WITH RIVERSIDE COUNTY OFFICIAL RECEIPT*
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PEST CONTROL BUSINESS COUNTY REGISTRATION
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
PEST MANAGEMENT AND LICENSING BRANCH
REGISTRATION EXPIRATION DATE: DECEMBER 31, 2016
_____________________
______________________
FOR REGISTRATION IN COUNTY OF:
BUSINESS LOCATION


RIVERSIDE
LIC. EFFECTIVE DATE
LIC. EXPIRATION DATE
MAIN
BRANCH
_____________________
______________________
(QAL) PCO LICENSE NUMBER
CATEGORIES
BUSINESS NAME: _____________________________________________
NAME:_________________________________________________________________________________
______________________________
_____________
BUS. LIC. #
________________________________________________
ADRESS:
ADDRESS: ______________________________________________________________________________________
_____________________________________________________________________________________
CITY
STATE
ZIP CODE
PEST CONTROL CARD INFORMATION AREA
CITY: ________________________________________________
STATE:________
ZIP: ______________
(ATTACH COPY OF PEST CONTROL BUSINESS LICENSE)
BUS. PHONE # : ________________________________________
REGISTRATION FEE RECEIVED $ ____________
EMAIL ADDRESS: ______________________________________________________________________________
AGRICULTURAL COMMISSIONER
QUALIFIED APPLICATOR’S SIGNATURE: _____________________________________ DATE: ____________
COUNTY OF RIVERSIDE
4080 LEMON STREET, ROOM 19
CONDITION(S) ATTACHED
Restricted Material(s) Possession Permit No._________________________
PO BOX 1089


No Restricted Material may be possessed except in accordance with any
YES
NO
RIVERSIDE, CA 92502-1089
attached condition(s). This is not a permit to apply.
AGRICULTURAL COMMISSIONER’S SIGNATURE
DATE
IMPRINTING COUNTY’S OFFICIAL SEAL

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Agricultural Pest Control Adviser County Registration Form Agricultural Pest Control Adviser County Registration Form Business
Business Tax Registration Form - City Of San Jose Business Tax Registration Form - City Of San Jose Financial
Business Opportunity Registration Form - Texas Secretary Of State Business Opportunity Registration Form - Texas Secretary Of State Legal
Business Agent Registration Form 2003 Business Agent Registration Form 2003 Legal
Form Ar-1r - Combined Business Tax Registration Form Form Ar-1r - Combined Business Tax Registration Form Financial
Form Ar-1r - Combined Business Tax Registration Form Form Ar-1r - Combined Business Tax Registration Form Financial
Form Ar-1r - Combined Business Tax Registration Form Form Ar-1r - Combined Business Tax Registration Form Financial
Structural Pest Control Business / Qualifying Manager Registration Form Structural Pest Control Business / Qualifying Manager Registration Form Business
Application For Pest Control Employee-identification Card Form - Florida Department Of Agriculture And Consumer Services Application For Pest Control Employee-identification Card Form - Florida Department Of Agriculture And Consumer Services Legal
Family Docket Control Order - County Court Form Family Docket Control Order - County Court Form Legal

Related Categories

Parent category: Life
Download
Go