Business Frontpage - Start Bootstrap Template

Please provide the following information:

Licensee Company :

Application Date:

Primary Certification

Sub-Certification

If sub-certification, list the name of the Certified Product.

Company Name:

Company Address:

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

(S-1)

List each ASTM Standardized Method used to document functionality claims.

ASTM Method Used: ASTM Method Used: ASTM Method Used:

ASTM Method Not Available:

(S-12)

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

Yes

(S-12)

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

Yes

(S-3)

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

Yes

(S-3)

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

Yes

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

Select file Change ×

(S-10)

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

Yes

(S-4)

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

Name:

Phone:

(S-6)

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

Warning

Danger

N/A

(S-7)(S-8)

10.

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

Yes

(S-7)(S-9)

11.

If intended functionality includes reference to surfactant, spreader, or wetting agent, list % surfactant guarantee. % OR *This must be separately listed on the label If % surfactant guarantee is provided above, are components claimed as surfactant, spreading or welting agent, water dispersible and reduce surface tension of water to 45 dynes/cm or less at 0.5% w/w, per ASTM Method D-1331?

Yes

N/A

(S-13)(S-13)

12.

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

(S-14)

OR N/A

13.

Provide the Unsulfonated Oil Residue (UR) value. % OR

N/A

(S-15)

14.

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?

Yes

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

Yes

*If yes to 15(b), then the state label(s) must be included in the application materials.

Select file Change ×

15.

Please upload the label of product to be certified

Select file Change ×

16.

Please identify the product(s) listed that <> is approved by the respective basic manufacturer(s) as a tank-mix component with its product(s).

(Check all that apply)

Enlist One

Enlist Duo

Eugenia

Tavium

XtendiMax

17.

is an oil emulsion formulation listing Drift Reduction Agent functionality and is recommended for use with Engenia, Stryax and Tavium herbicides.

Yes

18.

Toxicity Studies

Please choose one option below.

Option A: If the required toxicity data was generated by laboratory studies, please upload your 1-2 page toxicity study test results summary.

Select file Change ×

Option B: A Chemical Regulatory Database Software Program was used to determine the required toxicity data as recorded in Section 11 of the attached SDS. Please list the name of the software program.

19.

Please upload the product's SDS.

Select file Change ×

21.

Name Of Submitter

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

Thank you for completing the application. Please note, CPDA may be in contact with you for any questions or to request additional information needed during the application review 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).

Error!

Warning!

Success!

Info!

APPLICATION For CPDA SPRAY ADJUVANT CERTIFICATION

Part 1

Please provide the following information:

PART 2

Reference Standard

PART 2 Continued

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