Date 4300 B Form4300b
User Manual: 4300 B
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Commercial Fertilizer Product Registration (4300B Form) A Completed Form 4300A Must Accompany This Form PLEASE REFER TO INSTRUCTIONS TO COMPLETE THIS FORM COMPANY INFORMATION COMPANY NAME WSDA COMPANY # DATE DEPARTMENT USE ONLY WSDA Fertilizer Product Reg. Number Application Rate WSDA/EPA Pesticide Reg. No. Pesticide File No. PRODUCT INFORMATION PRODUCT NAME and GRADE (As it appears on the label) MAXIMUM LABELED RATE OF APPLICATION: (Only if the label contains application directions that can be converted to lbs/acre/year) Maximum rate of _____________ (lbs, gals, oz.) per______________ (acre or sq. ft.) _______ times a year (assume a 7-month growing season) (EX: 2X/Mo = 14 Times) If a liquid, enter pounds per gallons here ____________________ GUARANTEED ANALYSIS (%) N Ca B Cu Mo P2O5 Mg Cl Fe Na K2O S Co Mn Zn As Cd Co LIME CaCO3 MgCO3 GUARANTEED MAXIMUM METALS CONCENTRATION (PPM) Hg Mo Ni Pb GYPSUM CaCO3 (eq) Se CaSO4.2H2 O Zn ENTER A VALUE GREATER THAN OR EQUAL TO THE RESULT OR DETECTION LIMIT. (WHICHEVER IS GREATER) ND, BDL, MDL, ZERO AND BLANK ARE NOT PERMITTED. ECOLOGY INFORMATION Does your label guarantee any of the following: total nitrogen (N), available phosphate Yes No (Micronutrient Fertilizer) (P2O5), soluble potash (K2O), calcium (Ca), magnesium (Mg), sulfur (S)? Yes No (Waste-Derived) 2. Is your fertilizer free of all waste ingredients? If you answered “No” to either 1 or 2, follow the instructions on the most current Ecology Questionnaire for additional testing requirements. 1. (Please read all instructions before completing this form) A completed 4300B form is required for registration. An incomplete form will delay the processing of your application. PRODUCT INFORMATION: Product Name and Grade: Enter the complete name found on the product label. Include the grade (N-P-K) if it is not 0-0-0. Maximum Labeled Rate of Application: If the product label includes application rates, complete this section using the highest rate and maximum number of applications allowed during a growing season (a growing season in Washington is assumed to be 7 months.) Example: If a product’s directions for use state “Apply 1-3 lbs/1,000 sq. ft. once each month,” the calculation would be 3lbs x 1,000 sq. ft. x 7. Leave this section blank if the label has no directions for use. GUARANTEED ANALYSIS %: Enter the values to match the guaranteed analysis on the product label. Do not list values for nutrients not guaranteed on the label. The values must be entered as a percentage. Parts per million (ppm) and other methods of measurement are not allowed. All limes must include guarantees for calcium and/or magnesium carbonate (CaCO3 and/or MgCO3) and calcium carbonate equivalent (CaCO3eq). Gypsum must include guarantees for calcium sulfate (CaSO4.2H20) and sulfur. GUARANTEED MAXIMUM METALS CONCENTRATION (PPM): A value must be entered for each of the nine metals. It must be reported in parts per million (ppm) and must be equal to or greater than (≥) the value found on your laboratory report. If the laboratory report indicates ND (non-detect), BDL (below detection limit), or MDL (minimum detection limit), you must enter a value equal to or greater than (≥) the ND, BDL, or MDL. To account for variability in source material as well as sampling and analytical variation, many companies choose to report values higher than those found on the laboratory report. This is acceptable as long as the reported value allows the product to meet the established metals standards. Continued on next page AGR FORM 630-4300B (R/03/16) Page 1 of 2 COMPANY INFORMATION: Company Name: Enter the name of the company as it appears on the form 4300A. WSDA Company Number: You can find your company number on your current registration certificate. If you are applying for the first time, leave this box blank. Date: Enter the date you submit the registration. ECOLOGY INFORMATION: Solid waste is defined in chapter 70.95 and 70.105, but does not include biosolids or biosolid products regulated under chapter 70.95J RCW or waste water regulated under 90.48 RCW. A micronutrient fertilizer is defined as a fertilizer that guarantees B, Cl, Fe, Mn, Mo Na, or Zn, but does not guarantee N, P2O5, K2O, Ca, Mg or S. Products containing guano (bat, bird) are always considered waste-derived and must go through Ecology review. If you answered “No” to either 1 or 2, follow the instructions on the most current Ecology Questionnaire for additional testing requirements. FERTILIZER/PESTICIDE PRODUCTS: Dual products require registration as both a Fertilizer and a Pesticide. Information for Pesticide registration can be found at http://agr.wa.gov/PestFert/Pesticides/ProductRegistration.aspx. Mailing Address: Washington State Department of Agriculture Pesticide Management Division PO Box 42591 Olympia, WA 98504-2591 Physical Address: Washington State Department of Agriculture Pesticide Management Division 1111 Washington St. SE Olympia, WA 98504 IF YOU HAVE ANY QUESTIONS CONCERNING FERTILIZER REGISTRATION, please contact WSDA at (360) 902-2025 or by e-mail at fertreg@agr.wa.gov. AGR FORM 630-4300B (R/03/16) Page 2 of 2
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