Fertilizer & Soil Conditioner License Registration 30776 MDA Fert App Form 183914 7
User Manual: 30776
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PI-106 (Rev 9/17) Michigan Department of Agriculture & Rural Development P.O. Box 30776, Lansing, MI 48909 • 517-284-5771 FAX: 517-284-0458 www.michigan.gov/mda-fertilizer In accordance with 1994 Public Act 451, Part 85 as amended. Fertilizer & Soil Conditioner License / Registration Application License Year Ending: Dec. 31 Status: New Renewal No Longer Needed If Renewal, Unique ID or License No. of Establishment ____________________________ Business Information Submitter Name:_____________________________________________________________ Submitter Address:___________________________________________________________ City: ______________________________ State:________ County:____________________ Zip:___________________ Country:_____________________________________________ Phone: (_____)_______________________ Fax: (_____)____________________________ Manufacturer (Label) Name and Address if different from above:________________________ ___________________________________________________________________________ Blank Space For Official Use Only Address:____________________________________________________________________ City:________________________________ State:_________ County:___________________ Federal ID or EIN Number Zip:_________________ Country:________________________________________________ ___________________________ Contact Name:______________________________________________ Phone: (_____)___________ Fax: (_____)______________ Email:_____________________________________ Business Website www.______________________________________________ Resident Agent (Out-of-State Firms Only) Out-of-state firms must select one of the following: Michigan Resident Agent No Resident Agent (Opt Out) Resident Agent Name:_________________________________________ Address:____________________________________________________ Email:_______________________________Phone:(_____)___________ In lieu of a resident agent, the firm will maintain and make fertilizer and soil conditioner records required by law available to MDARD and pay all costs incurred by MDARD in auditing the records if they are held at an out-of-state location. Specialty Fertilizer & Soil Conditioner Product Registration (attach additional sheets if needed) Grade Product Name Check product type: Specialty Fertilizer = S Soil Conditioner = C Beneficial By-Product = B S C B S C B S C B S C B S C B Please submit 8.5” x 11” copy of the current label for each product N P K Fertilizer Manufacturer/Distributor & Soil Conditioner Facility License (attach additional sheets if needed) Facility:__________________________________________ Address:____________________________________________________ City:_____________________________________________ State: ______ County:____________________ Zip:_________________ License Fees (Please indicate all that apply) Total No. of registrations:________ @ $125.00 = $_____________ AOBJ: 0178 Lic • 0264 Reg • 0195 WQ Total No. of licenses:________ @ $100.00 = $___________ Payment Method: Check/Money Order No. _________________________________________ Amount enclosed:_______________ Please make check/money order payable to the State of Michigan and submit to the address at the top of the page. Remember to attach a product label or invoice with this application Signature:__________________________________________________ Date:___________________ Application continues on the back of this form Print name:_____________________________________Print title:________________________________ www.michigan.gov/mda-licensing Instructions 1. Complete the entire fertilizer application. 2. Submit a label or invoice for each product registration. 3. Check payable to the State of Michigan. 4. Return ALL of the above items to: Michigan Department of Agriculture & Rural Development Pesticide and Plant Pest Management Division P.O. Box 30776 (if payment is due) Use P.O. Box 30017 for all other correspondence Lansing, MI 48909 Use 525 W. Allegan, Lansing, MI 48933 for overnight delivery Types of Registrations and Licenses There are two types of registrations and four types of licenses: Registrations Licenses (one license covers all four uses per facility) 1. Specialty (non-farm use) fertilizer products 2. Soil conditioner products 1. Agricultural (farm use) fertilizer manufacturer/distributors 2. Specialty fertilizer custom blenders 3. Soil conditioner custom blenders 4. Beneficial Use By-Product Definitions Beneficial Use 3 By Products - The agricultural land application of certain by product materials (see the list below) is now overseen by MDARD. • The new license/registration of any beneficial use 3 materials on the list below must meet additional testing and labeling requirements. See www.michigan.gov/mda-fertilizer for an application. • Existing beneficial use 3 licenses/registrations (renewals) are not impacted, unless a raw material or generation process has changed. Beneficial Use 3 Materials 1. Coal Bottom Ash 2. Wood Ash 3. Pulp and Paper Mill Ash 4. Mixed Wood Ash 5. Cement Kiln Dust used as a Flue Gas Scrubbing Reagent 6. Lime Kiln Dust used as a Flue Gas Scrubbing Reagent 7. Foundry Sand from Ferrous or Aluminum Foundries 8. Pulp and Paper Mill Material 9. Dewatered Concrete Grinding Slurry from Public Transportation Agency Road Projects 10. Lime Softening Residuals 11. Soil Washed or Otherwise Removed from Sugar Beets 12. Segregated Flue Gas Desulfurization Material Grade - Means the percentage guarantee of total nitrogen (N), available phosphate (P2O5), and soluble potash (K2O), of a fertilizer. Indication of grade does not apply to peat or peat moss or soil conditioners. The grade needs to be in whole numbers. Specialty fertilizers with a guarantee less than 1% N, P or K (like 0.8%) and straight fertilizer materials may use a fraction. Custom blends may also use fractional units (tenths of a percent, like 10.5%). Resident Agent - Someone who is appointed by the licensee to receive any documents, notices, or demands served upon the licensee. The resident agent must be a Michigan resident, a Michigan corporation, a foreign corporation with a certificate of authority to transact business in Michigan, a Michigan limited liability company or a foreign limited liability company authorized to transact business in this state. Soil Conditioner - Any substance that is used or intended for use to improve the physical characteristics of the soil. Soil conditioner does not include guaranteed plant nutrients, agricultural liming materials, pesticides, unmanipulated animal or vegetable manures, hormones, bacterial inoculants, and products used in directly influencing or controlling plant growth. A soil conditioner with nutrient value claims is considered a fertilizer. Specialty Fertilizer - Any fertilizer distributed primarily for non-farm use, such as use in connection with home, gardens, lawns, shrubbery, flowers, golf courses, parks, and cemeteries. Water Quality Protection Fee - A fee of $100 per registered product is assessed in accordance with 1994 Public Act 451, Part 87, Groundwater and Freshwater Protection, and Part 85, Fertilizers. For additional questions, please visit our website at www.michigan.gov/mda-fertilizer
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