ATSSC Company
Information Form
(green sheet)
 
   
ATSSC COMPANY INFORMATION FORM
Company Name:
EPA Company # Fed Tax ID #:

Mailing Address
City   State Zip
Same as Mailing Address
Physical Address
City   State Zip
Contact Title:
Phone# Fax#:
Toll Free Emerg # Email:

MARK STATES IN WHICH YOUR PRODUCTS WILL BE REGISTERED
AL CT IN MA NV OH TN WI
AK DE IA MI NH OK TX WY
AZ FL KS MN NM OR UT
AR GA KY MS NJ PA VT PR
CA HI LA MO NY RI VA
DC ID ME MT NC SC WA
CO IL MD NE ND SD WV
ALL 51
(Includes DC)
ALL STATES except:

 

The following items are required for EACH PRODUCT AND BRAND NAME:

Electronic Files
: States are requiring the Product Label and MSDS in an electronic format. We appreciate getting any of the other documentation in an electronic format.

  1. LABEL: Ask your Graphic Artist or Label Printer to email an Adobe PDF file with the fonts embedded of the current actual product label artwork. (See ATSSC SOP#07 and SOP#16 for more "PDF information")
     
  2. MSDS: Material Safety Data Sheet and any other Technical or Specifications Information Sheets

  3. ESL: The most current EPA Stamped Label with EPA Comment Letter and any Notifications.

  4. CSF: The most current EPA Confidential Statement of Formula (EPA Form #8570-4).

  5. SUBREG: If your product is a Subregistration from another company, a copy of the EPA Notice of Supplemental Distribution of a Registered Pesticide Product (EPA Form #8570-5).

  6. ABN: If your product is an Alternate Brand Name a copy of the EPA Application for Pesticide Form (EPA Form #8570-1) filed with the EPA requesting the ABN.

  7. AGENT: If this is your first product for ATSSC, you will need to complete the EPA and State Agent letters.
    (See ATSSC SOP#14 and SOP#29 for more information.)