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5State of California
Department of Pesticide Regulation
FORMS REQUISITION
DPR-197 (Rev. 1/16)
Page 3 of 5
FORM NUMBER
FORM NAME
QUANTITY
PR-ENF-127
Pesticide Episode Investigation Report (Rev. 08/07) 50/pad
_________
_________
PR-ENF-127A
Pesticide Episode Investigation Supplemental Report (Rev. 08/07) 50/pad
PR-ENF-127B
Episode W itness / Injured / Complainant Report (Rev. 08/07) 50/pad
_________
PR-ENF-127C
Episode Site Diagram (Rev. 08/07) 50/pad
_________
PR-ENF-127D
Field W orker Dermatitis Supplemental Report (Rev. 08/07) 50/pad
_________
DPR-ENF-133
Medical Information Authorization (Rev. 07/13) 25/pad
_________
DPR-ENF-133X
Autorización de Información Médica (Rev. 07/13) 25/pad
_________
PR-ENF-182
Antimicrobial Exposure Episode Report (Est. 10/91) 50/pad
_________
PR-ENF-183
Production Agriculture Monthly Use Report: Multiple Site/Commodity
(Rev. 08/08) 25/pad
_________
PR-ENF-184
Production Agriculture Monthly Pesticide Use Report: Multiple Section
(Rev. 08/08) 25/pad
_________
PR-ENF-199
Pesticide Analysis Report (Rev. 05/04) 25/pad
_________
PR-ENF-211
Complaint Referral (Rev. 04/03) 50/pad
_________
PR-ENF-212
Complaint Referral – Supplemental (Rev. 04/03) 50/pad
_________
PEST MANAGEMENT AND LICENSING (PR-PML)
PR-PML-001
Qualified Applicator License Application Packet (Rev. 05/07)
_________
PR-PML-001A
Qualified Applicator Certificate Application Packet (Rev. 05/07)
_________
PR-PML-001A-WR
Qualified Applicator Certificate County Agricultural Commissioner Staff
Waiver Request (Est. 10/03) 50/pad
_________
PR-PML-004
Maintenance Gardener Pest Control Business Application Packet (Rev. 05/07)
_________
PR-PML-005
Aircraft Pilot Pest Control Certificate Application Packet (Rev. 05/07)
_________
PR-PML-006
Supplemental Information for Pest Control Business License (Fee Exempt)
(Rev. 02/02) 50/pad
_________
PR-PML-041
Pest Control Dealer Business License Application Packet (Rev.05/07)
_________
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