Application for CPDA Spray Adjuvant Certification

Application for CPDA Spray Adjuvant Certification

Licensee Company *

Application Date *

Submitted By: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Name of Product *

Checkboxes *

Primary Certification
Sub-Certification

List functionality claim(s) defined in ASTM E-1519 or ASTM E-609. *

Reference Standard: (S-1).

List each ASTM Standardized Method used to document functionality claims.

ASTM Method Not Available

Reference Standard: (S-12).

ASTM Method Used: *

ASTM Method Used:

Do the Principal Functioning Agents in the formulation perform to the claimed functions of the product?

Reference Standard: (S-12).

Is product labeled for and/or intended for use on food crops? *

Reference Standard: (S-3).

Are all product components listed in 40 CFR part 180 or applicable sections of 21 CFR? *

Reference Standard: (S-3).

Does the product label include specific recommendations for use in aquatic applications? *

Reference Standard: (S-10).

*If yes, aquatic toxicity assessment data must be submitted. General and other uses must not include aquatic use.

Is the product labeling and packaging compliant with U.S. DOT Regulations? *

Reference Standard: (S-4).

Does the product contain OSHA regulated hazardous materials? *

Reference Standard: (S-5).

*If yes, acute toxicity studies are required for inhalation and/or skin corrosion/irritation as applicable to the nature of the hazard.

Provide the name and phone number of 24 hour data service. *

First

Last

Phone *

Reference Standard: (S-6).

Identify the Product Hazard Signal Word (based on acute toxicity studies). *

Warning
Danger
N/A

Reference Standards: (S-7)(S-8)

Are the applicable precautionary and safety statements included on the label? *

Reference Standards: (S-7)(S-9).

If intended functionality includes reference to surfactant, spreader, or wetting agent, list % of surfactant guarantee. *

Checkboxes

Reference Standard: (S-13).

OR If % surfactant guarantee is provided above, are components claimed as surfactant, spreading or wetting agent, water dispersible and reduce surface tension or water to 45 dynes/cm or less at 0.5% w/w, per ASTM Method D-1331?

Reference Standard: (S-13).

Describe the type(s) of oil utilized. (If two or more types are used, list them in descending order of their compositional content.) *

Single Line Text

Reference Standard: (S-14).

Provide the Unsulfonated Oil Residue (UR) value. *

Reference Standard: (S-15).

All state labels bearing the Certification Mark must be identical to the approved national label with respect to all applicable Certification Standards.

(a) Is this product currently registered in any state? *

(b) Will this product bear the Certification Mark on the registered state label(s)? *

*If yes to (b), the the state label(s) must be included in the application materials.

Please upload the label of product to be certified. *

Click or drag a file to this area to upload.

Please upload a 1-2 page summary of the toxicity requried. *

Click or drag a file to this area to upload.

Please upload the product's SDS *

Click or drag a file to this area to upload.

By signing this document, I hereby certify that the information is true and correct to the best of my knowledge, and further, I certify the Principal Functioning agents in the product will perform all of the claimed functions.

Company Name

Signature

Thank you for completing the application. Please note, CPDA reserves the right to contact you with any questions or to request additional data or information needed to complete the application review and certification process. Upon submittal of this application you will receive an email confirmation of CPDA’s receipt of your application.

*The Certification Mark cannot be used on any label that has not been reviewed by the Certification Committee. If a product receives certification, existing state labels must be reviewed by the Committee prior to the mark being added to the state label(s).

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