­
2­
Blocks
16­
26.
Producing
Establishment
Information.
NOTE:
Blocks
16­
26
are
repeated
to
provide
space
for
registering
three
producing
establishments.
If
you
need
to
register
more
than
that
number,
photocopy
the
form
and
provide
requested
information
for
all
establishments
which
need
registration.
If
more
than
one
page
is
used,
complete
the
statement
"
This
is
page
__
of
__"
for
each
page.

Block
16.
Establishment
Name.
Each
establishment
registered
must
be
owned
and
operated
by
the
company
identified
in
Block
1..

Blocks
17­
20
­
Establishment
Site
Address.
Enter
the
street
or
route
location,
city,
state,
and
zip
code.
Include
if
applicable
the
building
or
building
subdivision
specific
to
the
producing
establishment.
DO
NOT
use
a
post
office
box.
Foreign
companies
should
use
country
abbreviations
shown
on
Instructions
­
Page
4
to
complete
Block
19.

Blocks
21­
24
­
Establishment
Mailing
Address.
Enter
the
establishment's
mailing
address,
if
different
from
the
site
address
shown
in
Block
17.

Block
25
­
NAICS
Code.
Leave
blank.

Block
26
­
Establishment
Dun
and
Bradstreet
Number.
Enter
only
if
different
from
the
company
Dun
&
Bradstreet
number
shown
in
Block
12.

Block
27
­
Name
of
Company
Officer.
The
company
officer
is
a
person
who
can
obligate
the
establishment
to
the
requirements
of
Section
7.
Please
type
or
print
the
name
clearly.

Block
28
­
Telephone
Number.
Enter
the
telephone
number
of
the
company
headquarters
officer
responsible
for
signing
the
application.

Block
29
­
E­
Mail
Address
(
Optional)
Enter
the
e­
mail
address
of
the
company
headquarters
officer
responsible
for
signing
the
application.

Block
30
­
FAX
Number
of
Company
Headquarters
(
Optional).
Enter
the
FAX
number
of
the
company
headquarters
officer
responsible
for
signing
the
application.

Block
31
­
Title
of
Company
Officer.
This
block
must
be
completed
for
the
application
to
be
processed.

Block
32
­
Date
Signed.
This
block
must
be
completed
for
the
application
to
be
processed.

Block
33
­
Signature
of
Company
Officer.
This
block
must
be
completed
for
the
application
to
be
processed.
Unsigned
applications
will
be
returned.

Public
Reporting
Burden:
For
this
information,
time
required
is
estimated
to
average
18
minutes
per
response,
including
time
for
reviewing
instructions,
searching
existing
data
sources,
gathering
and
maintaining
the
data
needed,
and
completing
the
reviewing
and
collection
of
information.
Send
comments
regarding
this
burden
estimate
or
any
other
aspect
of
this
information
collection,
including
suggestions
for
reducing
this
burden,
to:
Director,
OEI/
OIC
Collection
Strategies
Division
(
2823),
U.
S.
Environmental
Protection
Agency,
1200
Pennsylvania
Avenue,
NW,
Washington,
D.
C.
20460­
0001,
and
to
the
Paperwork
Reduction
Project,
Office
of
Information
and
Regulatory
Management
Affairs,
Office
of
Management
and
Budget,
725
17th
Street,
NW,
­
3­
Washington,
D.
C.
20503
(
Attention:
Desk
Officer
for
USEPA).
WHERE
TO
SUBMIT
APPLICATION
DOMESTIC
PRODUCERS:
Submit
application
to
the
following
EPA
Regional
Office
in
which
company
headquarters
is
located.

US
EPA
Regional
Offices
States/
Terr.
Covered
US
EPA
Regional
Offices
States/
Terr.
Covered
US
EPA
Region
I
Lee
Weller
Pesticides
Section
JFK
Federal
Building
Suite
1100
(
SEA)
Boston,
MA
02203­
2211
Telephone
617­
918­
1849
CT,
MA
ME,
NH
RI,
VT
US
EPA
Region
VI
James
Redd
Pesticides
Section
(
6PD­
P)
1445
Ross
Avenue
Dallas,
TX
75202­
2733
Telephone
214­
665­
7560
AR,
LA
NM,
OK
TX
US
EPA
Region
II
David
Salkie
Pesticides
Team
(
MS­
500)
Building
5
2890
Woodbridge
Avenue
Edison,
NJ
08837­
3679
Telephone
732­
321­
6750
NJ,
NY
PR,
VI
US
EPA
Region
VII
Lou
Banks
Pesticides
Branch
(
WWPD
/
PEST)
901
N.
5th
Street
Kansas
City,
KS
66101­
2798
Telephone
913­
551­
7125
IA,
KS
MO,
NE
US
EPA
Region
III
Kyla
Townsend­
McIntyre
Pesticides
Programs
(
3WC32)
1650
Arch
Street
Philadelphia,
PA
19103­
2029
Telephone
215­
814­
2045
DE,
DC
MD,
PA
VA,
WV
US
EPA
Region
VIII
Cornelia
Maes
Enforcement
Division
(
ENF­
PT)
999
18th
Street,
Suite
300
Denver,
CO
80202­
2466
Telephone
303­
312­
6049
CO,
MT
ND,
SD
UT,
WY
US
EPA
Region
IV
Jacquelyn
Wilkerson
AFC
Pesticides
Section
(
APTMD)
61
Forsyth
Street,
SW
Atlanta,
GA
30303­
8960
Telephone
404­
562­
9011
AL,
FL
GA,
KY
MS,
NC
SC,
TN
US
EPA
Region
IX
Glenda
Dugan
Pesticides
Section
(
CMD­
4­
3)
75
Hawthorne
Street
San
Francisco,
CA
94105­
3901
Telephone
415­
744­
1066
AZ,
CA,
HI,
NV
AS,
GU
US
EPA
Region
V
Gail
Muffitt
PTES
(
DT­
8J)
77
W.
Jackson
Blvd.
Chicago,
IL
60604­
3507
Telephone
312­
886­
6008
IL,
IN
MI,
MN
OH,
WI
US
EPA
Region
X
Eva
Chun
Pesticides
Unit
(
ECO­
084)
1200
Sixth
Avenue
Seattle,
WA
98101­
1128
Telephone
206­
553­
1970
AK,
ID
OR,
WA
FOREIGN
PRODUCERS:
Submit
application
to
the
following
EPA
Washington,
D.
C.
address:

US
Postal
Service
Mail
Address
Courier
Delivery
Address
Carol
L.
Buckingham
Carol
L.
Buckingham
(
Room
6102)
US
Environmental
Protection
Agency
US
Environmental
Protection
Agency
Agriculture
Division
(
2225A)
Agriculture
Division
1200
Pennsylvania
Ave.,
NW
1200
Pennsylvania
Ave.,
NW
Washington,
DC
20460­
0001
USA
Washington,
DC
20004
USA
Telephone:
202­
564­
5008
E­
mail:
buckingham.
carol@
epa.
gov
­
4­
FOREIGN
COUNTRY
ABBREVIATION
CODES
ARGENTINA
ARG
AUSTRALIA
AUS
AUSTRIA
AUT
BARBADOS
BRB
BELGIUM
BEL
BRAZIL
BRA
BULGARIA
BGR
CANADA
CAN
CZECH
REPUBLIC
CHK
CHILE
CHL
CHINA
CHN
COLOMBIA
COL
COSTA
RICA
CRI
DENMARK
DNK
DOMINICAN
REPUBLIC
DOM
ECUADOR
ECU
EL
SALVADOR
ELS
FINLAND
FIN
FRANCE
FRA
GERMANY
DEU
GUATEMALA
GTM
HAITI
HTI
HONG
KONG
HKG
HUNGARY
HUN
INDIA
IND
INDONESIA
IDN
IRELAND
IRL
ISRAEL
ISR
ITALY
ITA
JAMAICA
JAM
JAPAN
JPN
JORDAN
JOR
KENYA
KEN
LIECHTENSTEIN
LIE
MALAYSIA
MYS
MEXICO
MEX
MONACO
MCO
NETHERLANDS
NLD
NETHERLANDS
ANTILLES
ANT
NEW
ZEALAND
NZL
NICARAGUA
NIC
NORWAY
NOR
PAKISTAN
PAK
PANAMA
PAN
PAPUA
NEW
GUINEA
PNG
PERU
PER
PHILIPPINES
PHL
POLAND
POL
PORTUGAL
PRT
REPUBLIC
OF
KOREA
KOR
ROMANIA
ROM
RUSSIA
RUS
RWANDA
RWA
SCOTLAND
SCT
SINGAPORE
SGP
SLOVENIA
SLO
SOUTH
AFRICA
ZAF
SOUTH
VIETNAM
SVN
SPAIN
ESP
SWEDEN
SWE
SWITZERLAND
CHE
TAIWAN
TWN
TANZANIA
TZA
THAILAND
THA
TRINIDAD
AND
TOBAGO
TTO
TURKEY
TUR
UGANDA
UGA
UKRAINE
URK
UNITED
ARAB
EMIRATES
UAE
UNITED
KINGDOM
GBR
URUGUAY
URY
YUGOSLAVIA
YUG
VENEZUELA
VEN
Please
contact
US
EPA
Headquarters,
202­
564­
5008,
if
you
do
not
see
the
appropriate
country
code
here
­
5­
Common
Questions
and
Answers
Application
for
Registering
as
a
Pesticide/
Active
Ingredient/
and
Device­
Producing
Establishment
(
EPA
Form
3540­
8)

1.
What
is
an
EPA
company
number?
The
EPA
company
number
is
a
unique
identification
number
assigned
to
each
company
which
applies
for
product
registration,
distributor
registration,
or
establishment
registration.
The
company
number
encompasses
all
producing
establishments
owned
and
operated
by
the
company.

2.
What
is
an
EPA
establishment
number?
An
establishment
number
is
assigned
by
EPA
to
identify
a
particular
producing
facility.
It
is
composed
of
an
EPA
company
number,
a
two
or
three
letter
code
designating
the
state
or
country
where
the
producer
is
located,
and
a
number
indicating
the
order
of
the
establishment's
registration
within
a
given
state
or
country.
For
example,
80156­
NY­
002
indicates
that
this
is
the
second
establishment
for
EPA
company
number
80156
in
New
York.

3.
What
if
I
no
longer
want/
need
an
establishment
registration?
Notify,
in
writing,
the
EPA
Regional
Office
where
your
company
headquarters
is
located
(
domestic
producers)
or
the
Washington
office
(
foreign
producers);
see
Instructions
­
Page
3.
You
may
request
inactivation
at
the
time
you
complete
your
annual
production
report.
At
other
times
of
the
year,
send
a
letter
on
company
letterhead
requesting
inactivation
of
an
establishment.
The
letter
must
include
the
establishment
number
you
wish
to
inactivate.
Registration
numbers
may
be
reactivated
if
the
need
to
produce
becomes
apparent
in
the
future.

4.
If
I
change
the
address
of
my
establishment,
what
happens
to
my
establishment
number?
Your
establishment
number
stays
the
same
if
you
stay
in
the
same
state.
If
you
move
the
establishment
to
a
different
state,
you
must
apply
for
a
new
number.

5.
What
if
there
is
a
change
to
the
company
name
or
address?
You
must
notify
EPA
of
a
name
or
address
change
within
30
days
of
that
change.
This
applies
to
changes
for
the
company
headquarters
as
well
as
the
establishment.
See
Instructions
­
Page
3.

6.
I
would
like
to
read
the
regulations
about
pesticide
producing
establishments.
How
can
I
get
them?
Regulations
pertaining
to
establishment
registration
are
in
Title
40,
Part
167
of
the
Code
of
Federal
Regulations.
They
are
available
on
the
Internet
at:
http://
www.
access.
gpo.
gov/
nara/
cfr/
cfr­
table­
search.
html.
A
copy
of
regulations
may
also
be
obtained
from
contacts
listed
on
Instructions
­
Page
3.

7.
My
company
receives
pesticides
in
large
containers
and
transfers
the
products
to
smaller
containers
with
new
labels.
Do
I
need
to
register
as
a
pesticide­
producing
establishment?
Yes.
Any
change
to
the
label
or
container
of
a
pesticide
constitutes
"
production"
and
must
be
done
in
a
registered
establishment.
In
addition,
repackaging
of
bulk
pesticides
into
minibulk
tanks
or
other
reusable
containers
constitutes
"
production"
and
must
be
done
in
a
registered
establishment.
Contact
your
EPA
Regional
Office
(
see
Instructions
­
Page
3)
for
information
on
the
transfer
of
bulk
pesticides.

8.
Must
I
register
my
establishment
if
I
only
custom
blend
pesticides
for
my
customers?
An
establishment
where
only
custom
blending
activities
take
place
does
not
have
to
register
as
a
pesticide­
producing
establishment
or
report
production.
An
establishment
that
custom
blends
in
addition
to
other
pesticide
production
activities,
must
register
as
a
pesticide­
producing
establishment
and
report
production
only
for
the
other
pesticide
production,
not
the
custom
blending
activities.
"
Custom
blender"
is
defined
as
any
establishment
which
provides
the
service
of
mixing
registered
pesticides
to
a
customer's
specifications,
specifically,
a
pesticide­
pesticide,
pesticide­
fertilizer,
or
pesticide­
animal
feed
mixture
WHEN
the
blend
is
not
held
in
inventory,
the
pesticide
used
in
the
blend
bears
end­
use
labeling
which
does
not
prohibit
the
use
of
the
pesticide
in
the
blend,
and
the
blend
is
delivered
to
the
end­
user
with
the
labeling
of
the
pesticide(
s)
used
in
the
blend
and
a
statement
specifying
the
composition
of
the
mixture.
If
these
conditions
are
not
met,
the
establishment
does
not
come
within
the
definition
of
"
custom
blender"
and
must
comply
with
Section
7
requirements.

9.
Pesticide
Production
Reports
While
the
Agency
mails
the
pesticide
annual
report
form
(
EPA
Form
3540­
16)
to
companies
at
the
end
of
each
year
to
assist
them
in
fulfilling
their
reporting
obligations,
the
reporting
requirement
is
not
waived
if
the
mailing
does
not
reach
your
company.
It
is
your
company's
responsibility
to
report
production
amounts
annually.
If
a
report
form
is
not
received,
contact
­
6­
EPA
as
directed
on
Instructions
­
Page
3.
