I. PURPOSE 

United States Department of Agriculture 

Animal and Plant Health Inspection Service 

WS Directive 

PESTICIDE USE 

2.401 12/08/2009 

This directive will provide for the safe and effective storage, disposal, recordkeeping, and use of 

pesticides. It is also intended to mitigate releases of pesticides due to fire and non-fire events. 

This directive does not apply to sanitizers and disinfectants. 

2. REPLACEMENT HIGHLIGHTS 

This directive revises WS Directive 2.401 dated 10/\9/09. 

·3. POLICY 

Wildlife Services (WS) activities will be in compliance with applicable Federal, State, Tribal, 

and local laws and regulations pertaining to pesticides, including application, certification, 

storage, transportation, shipment, disposal, and supervision, or when recommending the use of 

restricted-use pesticides. Restricted use pesticides used or recommended by WS personnel must 

be registered by the U.S. Environmental Protection Agency (EPA) and the appropriate State 

regulatory agency. 

WS personnel are responsible for all aspects of control operations involving WS restricted-use 

pesticides having label language that specifies ''for use only by USDA personneL or persons 

under their direct supervision." Furthermore, pesticides displaying restriction-specific labels, 

and all derived chemical products, will not be transferred or otherwise released to non-authorized 

personnel per label restrictions. This restriction does not preclude or limit reimbursement to WS 

for any cost of materials or services provided involving these pesticides. 

Pesticide use, storage, and disposal will conform to label instructions and other applicable 

regulations and laws. Before using any pesticide, WS personnel will be trained in its proper and 

safe use. 

For field applications, where other decontamination equipment of sufficient quantity and type is 

not readily available; WS personnel must carry a decontamination kit containing at least one 

quart of water, coveralls, disposable towels, and soap. 

WS personnel will not conduct operational activities on private property where other persons are 

known to be using the same or a similar pesticide( s) intended for control of the same target 

species. WS equipment, materials, and warning signs will be promptly removed from the area if 

such use is discovered. WS will notify the property owner or manager of this action. 
Material Safety Data Sheets and labels for each pesticide used by WS must be provided to all 

WS personnel and other potential users. 

All pesticides, restricted-use or not, must be stored according to label directions in a locked or 

secured box, building, or vehicle when not in use. Warning signs or symbols required by Federal, 

State and Tribal laws and regulations must be displayed in the appropriate locations. Pesticides 

must be used in accordance with the WS' Standard for Storing PestiCides (See Attachment I). 

All unusable pesticides and by-products will be handled in a manner prescribed by the State 

Director and in accordance with EPA and State procedures and product labeling. State Directors 

are responsible for establishing proper accounting and monitoring procedures for all pesticides 

used in their program. 

4. RECORDKEEPING REQUIREMENTS 

Minimum recordkeeping for Federally registered, restricted-use pesticides require that the 

following information be recorded within 30 days following the pesticide application and be kept 

on file for at least 2 years [Note: State pesticide regulatory agencies may require additional 

recordkeeping and enforce longer retention dates]: 

a. The brand or product name, and EPA registration number of the restricted-use pesticide that 

was applied; 

b. The total amount of restricted-use pesticide applied; 

" 

c. The location of application, size of the area treated, and crop, commodity, stored product, or 

site that a restricted-use pesticide was applied; 

d. The month, day, and year when restricted-use pesticide application occurred; and, 

e. The name and certification number of the certified applicator who applied or who supervised 

the application of restricted-use pesticide. 

An inventory record will be maintained for pesticides in the Management Information System, 

Control Materials Inventory Tracking System. Records will be evaluated by Headquarters staff 

with periodic spot checks by designated officials. 

Any toxic or adverse human effect which occurs to WS personnel, cooperators, or the public 

involving use, storage, or disposal of any pesticide registered by USDA, APHIS is to be 

immediately reported to the State Director and Director (as designated in Directive 1.101) with 

details recorded on WS Form 160 (2007) and WS Form 160A (2007), The forms serve to 

document the incident in sufficient detail to allow the Safety, Health and Environmental 

Protection Branch to determine if further investigation is needed. The Operational Support Staff 

Director, or designee, will report the incident and submit specifics to the APHIS, Environmental 

Services Director, as appropriate. An adverse human effect is defined by EPA as an incident in 
which a person suffers an adverse physiological or behavioral effect (other than local damage to 

or irritation of the skin or eye of the type commonly associated with dermal or ocular exposure 

when the label provides adequate notice of such a hazard). 

Incidents and/or accidents resulting from the use of pesticides must be immediately reported to 

the appropriate supervisor and to the WS Safety and Health Council. The WS Safety and Health 

Council are responsible to investigate and/or coordinate the investigation of any incident or 

accident related to the use of pesticides. A complete documented investigation must be 

performed by a competent person for any significant accident. A significant accident is defmed 

as a death of any person, or a three-day (or more) lost time accident of an employee. The 

council will report any findings and recommendations to the WS Management Team in order to 

prevent a reoccurrence of such an incident. 

Additionally, WS personnel are required to report to the State Director, any knowledge of 

adverse incidents involving APHIS registered products. An adverse incident has occurred if a 

person or nontarget organism is exposed to and/ot has an adverse effect from a pesticide. 

5. REFERENCES 

. Federal Insecticide, Fungicide, and Rodenticide Act (7 U.S.C. 136 et ~.), as amended. 

Food, Agriculture, Conservation, and Trade Act of 1990 (FACT Act). 

National Environmental Policy Act (public Law 91-190, 42 U.S.C 4321 et seq.). 

40 CFR Part 153.75 - Toxic or Adverse Effect Incident Reports, (a)(1)(i) through(iii). 

Federal Register Vol. 58, No. 67 p. 19014. 

National Fire Protection Association (NFPA) 434, Code for the Storage of Pesticides. NFPA 

30B, Flammable and Combustible Liquid Code. 

NFPA 30B, Storage of Aerosol Products. 

Deputy Administrator 
ATTACHMENT I 

INTRODUCTION 

STANDARD FOR STORING PESTICIDES 

WILDLIFE SERVICES (WS) 

The purpose of this Standard is to provide information for safe worksites for employees and safe storage 

of pesticides, identify appropriate waste disposal methods, and define an adequate pesticide inventory 

and its contents. 

DEFINITIONS 

This Standard defines typical nomenclature involved in safely storing pesticides. These terms are 

important in understanding the applicability and scope of this Standard. 

Material Safety Data Sheet. A document produced by the manufacturer that describes the pesticide 

content and specifications, hazardous properties, disposal and safety information. 

Pesticide Container. Any drum, bag, box, bottle, carton, jar, pressurized container, or other closed 

vessel containing a pesticide, or pesticide residue, having an attached product label and used as the 

pesticide's primary container. 

Pesticide Inventory. A written record containing the following information for each pesticide being 

stored, regardless of quantity: 

• Name of pesticide; 

• EnvironnientalProtection Agency (EPA) registration number; 

• Quantity transferred, used, disposed of; and 

• Beginning and ending balance. 

Pesticide Storage CahinetIBox. A WS-approved storage cabinet or box used for the sole purpose 

of storing pesticide containers. 

Pesticide Storage Site. A storage site for general and restricted-use pesticides approved by WS for 

long-term storage such as a central storage/distribution facility or residential site or temporary 

storage of pesticides such as at a residence or in a vehicle overnight. Storage areas can be 

categorized as: 

• Incidental storage sites. Incidental storage sites are areas which contain less than 500 total 

pounds (lbs.) of solid or liquid pesticide with each pesticide not exceeding the incidental total 

for anyone pesticide (Table I). Even though incidental storage provides for exceptionally 

small quantities of pesticides, general storage requirements regarding security must still be 

implemented, 
• Small quantity storage sites. These sites are defined as areas that exceed the requirements 

of an incidental storage site, but not exceeding 1,000 total pounds of solid or liquid pesticide 

and not exceeding the small storage total for anyone pesticide (Table I). Even though small 

storage sites hold small quantities of pesticides, general storage requirements regarding 

security must still be implemented. 

• Large quantity storage sites. These sites are defined as bulk storage areas tha~ contain 

over 1,000 total pounds of solid or liquid material. 

Pesticide Weight. The weight of pesticide is determined as the weight of active pesticide ingredients 

and does not include the weight of capsules, containers, etc. 

Ready Supply. A quantity of pesticide kept on-hand sufficient to complete an identified project, 

concurrent projects, or to conduct up to a week of work. However, when an employee is required to 

travel an extensive distance to pickup the pesticide from a central storage/distribution facility, or 

when there are other extenuating circumstances, the supervisor can extend the ready supply rule to a 

longer period. 

Restricted-Use Pesticide. Pesticides classified as restricted use under the Federal Insecticide, 

Fungicide and Rodenticide Act (FIFRA) in 40 CFR, Part 152.175 and can only be used by 

applicators certified to use them. 

Secondary Containment. Any container or device that prevents a release of pesticide material into 

the environment when the primary pesticide container fails. 

Worksite. For the purpose of this Standard, a worksite is defined as an office, warehouse, 

residence, or other ground location where employees base their work. Restrictions on pesticide 

storage at residential sites apply (see Residential Storage Sites below). 

GENERAL STORAGE REQUIREMENTS 

The following are general requirements that apply to all pesticide storage sites. All pesticides must be 

stored: 

I. In full compliance with EF A and appropriate State pesticide label requirements. 

2. In closed containers, at WS-approved worksites. 

3. So that only employees approved by the State Director, Field Station Leader, Project Leader, or 

their designee, will have access to pesticides. 

4. Separate froin food and personal contact items such as clothing, linens, furniture, animal feeds 

and animal health products. 

5. To minimize contact with moisture, excessive heat or freeze/thaw cycles, or other environmental 

conditions that affects the container integrity or product stability. 

6. Away from open-flame devices such as cutting and welding torches and furnaces without an 

evaluation to ensure these sources will not ignite any pesticides. A "burn permit" may be 

required. 
_..--- --~-- ----------------

7. To prevent theft. Unattended pesticides must be locked at all times to prevent theft or 

unauthorized use. Pesticides must not be left in motel rooms or other unsecured locations. Notify 

the. supervisor immediately if a theft or loss occurs. 

8. With a current, up-to-date, pesticide inventory, available to emergency responders, auditors, and 

other authorized persons. 

9. In a manner that segregates any incompatible pesticides. 

to. In a inanner to prevent run'off or leaching into the environment, paying particular attention to 

waterways, ·such as, streams, drinking water protection zones, well heads, lakes, rivers, and other 

waters. 

In each office or warehouse where pesticides are stored, a current Occupant Emergency Plan (GSA 

Form 3415) must be in place. 

Banned or unapproved pesticides will not be used or stored at any WS facility. Refer to the section 

Waste Disposal for appropriate disposal procedures. 

Pesticide Containers. All pesticide containers having pesticides or residue will be: 

• Properly labeled (legible FIFRA label on the outside of the container). Labels must not be 

removed from original container. 

• Free from rust and leaks. 

• Stored appropriately in an approved pesticide cabinetlbox or at an officially designated central 

storage/distribution facility. 

Pesticide Cabinets and Boxes. WS approved pesticide cabinets and boxes must be: 

• Made of metal, hard high-density plastic or another non-combustible material of substantial 

construction to minimize the risk of vandalism. 

• Fire and weather resistant with sturdy hinges, locks and hasps. 

• Clearly labeled to depict the hazard such as "Danger - Poison" with a skull and cross bones, as 

appropriate. 

. • Stored, if applicable, where adequate fire extinguisher or spill containment and collection 

materials (items used to clean-up a spill, i.e. sealable plastic containers, rags, paper towels, 

broom, dust pan, etc.) are readily available. 

• Dedicated to pesticide storage only. 

Central Stotageillistribution Facilities. These facilities are generally located at State, District, or 

Field Offices, and/or their affiliated warehouse buildings. These sites can be designated as 

incidental, small-, or large-quantity storage sites. The primary function of a Central Storage or 

Distribution Facilities is for the distribution or transfer of smaller amounts or "ready supply" of 

pesticides to WS employees for their use. Access to pesticides should be limited to one or two 

designated persons who are responsible for distribution, inventory, recordkeeping, and disposal 

under FIFRA, and when applicable, under the Resource Conservation and Recovery Act (RCRA). 

In addition to the general storage requirements, the following requirements apply: 
Incidental Storage Sites~ Storage sites meeting the definition of incidental storage, will 

meet all general storage requirements. 

Small-Quantity Storage Sites. In addition to the general storage requirements, smallquantity storage sites will provide a locked pesticide storage cabinet, or, if appropriate, 

flammable liquid storage cabinet constructed of noncombustible materials if the pesticide is 

flammable or combustible in a dedicated room that is appropriately ventilated. In addition: 

I. Smoking is prohibited in all storage areas containing pesticides and "No Smoking" 

signs will be conspicuously posted at all entrances to storage areas. 

2. A fire extinguisher and spill kit (if applicable) must be located within 30 feet of the 

storage area. 

3. If pesticide transfer operations will be performed, e.g., from one container to another 

container, personal protective equipment and the availability of an emergency 

eyewash system (permanent or portable) or a shower should be available, dependent 

on the nature of the potential exposure. 

4. The most recent pesticide inventory, MSDS, and emergency response information or 

contact phone numbers will be maintained and readily available on-site. 

s. All storage lockers will be signed with the appropriate "State-approved" sign. 

6. All pesticide-containing compressed gas cylinders must be located in a secured 

outdoor, covered area. 

7. Accumulation of combustible materials or trash in pesticide storage area is prohibited. 

8. All containers must be in secondary containment to prevent pesticide spills into the 

environment. Examples of secondary containment for liquids include polyethylenelined tubs, dikes, curbing, and double-walled tanks, and for non-liquids, a pesticide 

storage cabinet or box, as defined below. 

Large-Quantity Storage Sites. In addition to the general requirements and small-quantity 

storage site, large-quantity storage sites shall not be located in basements or buildings of 

combustible materials. In addition, the following characteristics will apply to all largequantity storage sites. 

1. Pesticide spills must be able to be coritained within the inside of the facility or 

directed to an exterior holding tank. The spill capacity shall be equal to the largest 

pesticide container capacity plus 10 percent. 

2. Building floors must be constructed and maintained to contain spills and prevent 

emergency conditions in adjoining occupied areas or buildings. Floor drains must be 

plugged. 

3. The building must be illuminated to allow identification of pesticide container 

labeling. 

4. All exterior, large"quantity storage areas will have appropriate hazard identification. 

Generally, NFPA 704, Standard Systems for the Identification of the Hazardous of 

Materialsfor Emergency Responders (the diamond system) will be used. In addition, 

a State-approved sign, or a placard that reads PESTICIDES in black 2 inch letters on 

a white background shall be posted. . 

5. Storage of incompatible materials shall not be within 25 feet of affected pesticide 

unless protected by I-hour fire-rated material. . 
6. The building will be equipped with automatic fire detection and suppression systems. 

(Caution: The selection of an extinguishing agent(s) must be carefully considered 

such that the chemical properties of the pesticide and extinguishing agent are 

examined to ensure compatibility. Some pesticides have chemical properties that 

pose escalated fire risk. For example, if an aluminum phosphide fumigant contacts 

water, it produces phosphine gas, a highly flanunable gas that self-ignites at 100° C. 

In this case, water-based sprinkler systems should not be used. Perhaps, a better 

choice would be an ABC Multi-purpose or non-ozone depleting fire extinguishing 

agent. Note: Halon-based extinguishing agents should not be used.) 

7. A written risk assessment should be conducted to determine an appropriate storage 

facility location. Some factors to consider include: 

• The capacity for effective arid safe evacuation 

• Nearby human populations 

• Unique or high~value environmental resources nearby 

• In the case of fire, could human exposures be prevented or adjacent property 

and enviroiunental assets be protected 

• Chemical properties 

• Mixed product storage 

• Smoke and liquid runoff 

• Emergency response capabilities 

Residential Storage Sites. When it is necessary for authorized employees to store small quantities 

of pesticides at their residences, the storage area at a residential location is classified as a worksite, 

and all the aforementioned general storage, pesticide container, pesticide cabinet, and inventory 

requirements apply. In addition, the following will apply: 

I. Storage and storage area must be authorized by the State Director in writing. 

2. Storage will be inside an approved, locked pesticide storage cabinet or box. 

3. Pesticides must be inaccessible to family members and visitors at all times. 

4. Pesticides will not be stored inside of residences. An attached garage is not 

considered inside the residence. 

5. If an employee's residence is located at a community dwelling such as an apartment 

complex or condominium, an approved alternative site must be obtained. 

6. A fire extinguisher will be maintained in close proximity to the storage site/area. 

TRANSPORTATION OF PESTICIDES AND OVERNIGHT STORAGE IN A VEmCLE 

A "ready supply" of pesticides may be transported or stored overnight onboard Govemment- owned 

vehicles and enclosed trailers, or personal vehicles authorized for "Official Use" by the State Director. 

However, the following wiH apply: 

1. All pesticides, except for large quantities of bagged grain baits, must be in an 

approved, locked storage box kept inside the vehicle, or in a locked storage box kept 

in a substantial locked tool box (or equivalent) that is permanently attached to the 

vehicle. Large quantities of bagged grain baits may be transported outside a pesticide 

storage box, but may not be left unattended. Overnight storage of bagged grain bait 
m~st be in an approved pesticide storage cabinetlbox, as necessary. Bagged grain 

baits can be temporarily stored in a vehicle as long as the truck bed or trailer is 

enclosed and locked, and the baits are covered to protect them from public view. 

2. The vehicle must be locked when unattended. 

3. Highly toxic or hazardous inhalation pesticides such as aluininum phosphide will not 

be carried or stored in the passenger compartment of a vehicle . . 

4. Pesticide labels and MSDS will be transported with pesticides at all times. 

If an employee's residence is located at a community dwelling such as an apartment complex or 

condominium, an approved alternative storage site must be identified. . 

TRAINING 

A training program will be required for all employees who handle pesticides at any storage facility. The 

training will be based on the review of current MSDS, labels, and other pertinent information, and must 

include storage requirements, personal protective equipment, emergency procedures including 

appropriate notification, and proper waste disposal. 

A Hazard Communication Program will be implemented and maintained for each pesticide storage 

worksite. (Refer to APHIS Safety and Health Manual, Chapter 10, Section· 8, Hazard Communication 

and OSHA regulation 29 CFR 1910.1200, Hazard Communication.) 

INSPECTIONS 

Inspections of small- and large-quantity storage sites are required twice annually at a minimum. 

Inspections will be documented at all central storage/distribution facilities with the APHIS Safety 

Inspection Checklist (APHIS Form 256-5) and at overnight residential or vehicle storage sites with the 

less time-consuming and easily performed self-inspection checklist (Enclosure 1). Employees who 

conduct self-inspections at vehicle storage and residential sites (two per year minimum) will forward the 

inspection reports to the SDlField Station leader and retain copies for their files. 

The SDlField Station Leader will verify the accuracy of the self-inspection checklist and APHIS Safety 

Inspection Checklist (APHIS Form 256-5) and take appropriate actions to correct any deficiencies. 

EMERGENCY PROCEDURES 

Facilities storing pesticides will have adequate written emergency response procedures to include 

emergency evacuation plans and contact phone numbers, and adequate emergency equipment such as 

fire extinguishers, spill kits, and personal protective equipment, as needed. Actions and appropriate 

notifications must be consistent with the pesticide stored and the hazard potential. Additional 

information can be obtained from the APHIS Safety Health and Environmental Protection Branch 

(SHEPB), Environmental Protection Program by calling 301-734-5577 or 301-734-0626. 

The local fire department should be notified of pesticide materials stored at WS worksites, especially if 

there areflarnmable or explosive materials being stored at the site. All appropriate NFPA 

redlblue/yellow (frrelhealthlreactivity) diamond signs should be placed on storage cabinets or on the 
-- 

_. __.

outside doors of storage buildings to identify potential hazards to the emergency response personnel. 

Additionally, State, county, and city regulations and ordinances must be checked for more restrictive 

"Notification Requirements." 

WASTE DISPOSAL 

Pesticide-contaminated materials must be disposed of or decontaminated in accordance with appropriate 

Federal, State, Tribal and local regulations and as specified by the manufacturer's instructions listed on 

the product label or MSDS. SHEPB has established GSA Blanket Purchases Agreements with 

hazardous waste disposal firms for use by APHIS Field Offices. Contact SHEPB at 301-734-5577 to 

arrange a pickup and to request funding. Funding assistance may be available from the Environmental 

Protection Program Delivery account. Additionally, your State pesticide regulatory agency may have a 

Pesticide Disposal Program and many of these programs are free, depending on the quantity of 

pesticides to be disposed and timing, often States have an annual pickup or disposal event. 

Table 1. Pesticide limits for incidental, small and large quantity storage facilities • 

. Storage Weight Criteria 

Pesticide Incidental Small Quantity Large Quantity 

Cyanide (concentrate) <0.2 lb. >0.2 Ibs. and <20 lbs. >20Ibs. 

M-44 (total weight) <0.5 lb. >0.5 lbs. and ~O lbs >20lbs 

DRC 1339 (Concentrate- ::51 lb. > 1 Ibs. and ::5100 lbs. >IOOlbs 

weight of active ingredient 

only) 

'DRC 1339 (Mixed - weight ::5100 lbs. > I 00 lbs. and ::51000 lbs. >10001bs 

, of total product) 

Gas Cartridges (total ::5100 lbs. > 1 00 lbs. and ::51000 lbs > IOOOlbs 

weight) . 

Strycluiine (Concentrate- ::51 lb. > 1 lbs. and ~O lbs >20Ibs. 

weight of active ingredient 

dilly) 

Strycluiine (Mixed weight ::5100 lb. > 1 00 Ibs. and ::51000 lbs. >IOOOlbs. 

of total producQ ' 

Zinc phosphide (total ::51O Ibs. > 1 0 Ibs. and ::5500 Ibs. >500Ibs. 

weight) . 

Aluminum phoshide (total ::510 lbs > 1 0 Ibs. and ::5500 lbs. >500Ibs. 

weight) 

All other Liquid ::5Ub. >Ilbs. and ::5100 Ibs > 100 Ibs 

Concentrates (active 

ingredient) 

All other liquid and solid ::5100 lb. > \ 00 Ibs. and ::51000 Ibs. > \OOOlbs. 

pesticide that are non 

concentrates and nonacutely hazardous to life 

I (total amounj} 
A IT ACHMENT 2 

GUIDELINES FOR APPLICATION 

Compound DRC-1339 Concentrate Feedlots (EPA Reg. No. 56228-10) and 

Compound DRC-1339 Concentrate - Staging Areas (EPA Reg. No. 56228-30) 

for European Starling Management 

Application of Compound DRC-1339 will be conducted in a safe and scientifically responsible manner 

consistent with the principles of transparency, accountability, and cost effectiveness. Towards this goal, 

State Directors will implement the following guidelines in developing and initiating control actions 

using DRC-1339. on European Starlings under these two labels. 

State Directors will prepare tWo implementation plans (I urban/suburban, I rural) as appropriate for 

their respective State(s) that will provide guidance to field employees applying DRC-1339. The plans 

will be provided to the Regional Office for approval and will include, but are not limited to, the 

following: . 

• Application ofDRC-1339 in/near urban/suburban areas will occur during Monday - Wednesday. 

Deviation from these days may occur after prior Regional Office approval on a case-by-case 

basis. 

• Approved urban/suburban treatments on days other than Monday - Wednesday will require the 

availability ofWS personnel over the weekend and/or holiday to answer calls from the affected 

public, and availability of WS or cooperators for carcass collection/disposal. 

• Each WS State Office utilizing DRC-1339 for starling control under these labels will utilize 

written informational materials that include WS contact information and issues related to starling 

damage inanagement with DRC-1339 in that state. 

• A list of entities to receive prior notification ofWS planned use ofDRC-1339 shall be developed 

by each State Director and included in the implementation planes). The list shall contain at leas.t 

the affected Township/City and appropriate state agencies (e.g. state wildlife management 

agency, cooperative extension, health department). 

• Prior to the application, WS will notifY entities listed above of treatment date, generalized 

location of treatment, and general purpose for the application. Notification may be via telephone 

conversation, face-to-face meeting, or written material. Such notification shall be documented by 

WS (date, time, mode, what was communicated, and name/affiliation ofindividuaJ). 

• For urban/suburban areas, WS personnel shall coordinate collection of bird carcasses, by WS 

personnel, cooperators, or other officials. The area searched for carcasses will vary, depending 

on habitat and treatment conditions. Priority shall be given to public properties, especially those 

containing suitable bird habitat within 2 miles of the treatment site, and private properties where 

homeowners have requested assistance with collecting carcasses. 
• Carcass disposal must comply with applicable State and locallawsand regulations. 

• Both implementation plans must receive Regional Office approval before any new work can be 

initiated. 
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Enclosure I 

Wildlife Services 

Self-Inspection Checklist 

Residential Storage Sites 

For 

Pesticides, Pyrotechnics, Rocket Net Charges 

AndlOr 

Incidental Explosive Materials 

[nspectoT ________________ Telephone Number ______ Date ______ _ 

Residential Site Location ______________________ -'..• or 

License Plate No. for Storage Vehicle ______ .; Gov·1. Vehicle _______ Private Vehicle _____ _ 

at least 3-A:40- B:C is recommended for explosive 

storage 

I certify that the above information is correct and valid 

Inspector's Signature Dale 

State Director/Field Station Leader/Project Leader or Designee Date 

WS Fonn39