Fillable Printable Agriculture Addendum

Agriculture Addendum

BLS-700-307 (10/10/17)

Agriculture Addendum

This supplemental form may only be submitted as an attachment to the Business License Application.

For assistance or to request this document in an alternate format, visit http://business.wa.gov/BLS or call 1-800-451-7985. Teletype (TTY) users may call 360-705-6711.

State of Washington

Business Licensing Service

PO Box 9034

Olympia, WA 98507-9034

1-800-451-7985

A Basic information

Business name

B Complete this section for Pesticide Dealer

Name of designated dealer-manager for this location License qualication number

2. If this is an out-of-state rm, complete the agent information below. The agent must reside in Washington.

Legal agent name

Legal agent address City State

Zip code

C Complete this section for Nursery Retailer/Wholesaler

1. Indicate which one of the following describes your primary nursery business activity:

Garden center Propagation/production Landscaper Landscape supplier Florist

2. Are you propagating plant material?....................................................................................................

Yes No

3. Do you ship plant materials out of Washington? .................................................................................

Yes No

Do you propagate Chaenomeles, Crataegus, Cydonia, Malus, Prunus, Pyrus, Sorbus or Vitis? .......

Yes No

UBI

Owner name

Complete this section for Egg Dealers and Handlers

(Check one or more boxes for all facilities)

Exemption (check only if applicable)

My operation has fewer than 3,000 laying chickens, or

My operation produces eggs/egg products from turkeys, ducks, geese, guineas, or fowl other than domestic

chickens

I certify that I understand the applicable standards that meet all of the requirements of RCW 69.25.065 and:

The eggs and egg products are produced by commercial egg layer operations that comply with the 2010 version

of the United Egg Producers Animal Husbandry Guidelines, or

2. The eggs and egg products are produced by commercial egg layer operations that comply with an equivalent

version of the 2010 United Egg Producers Animal Husbandry Guidelines.

Name of equivalent guidelines __________________________________________________________________

Continued on next page...

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BLS-700-307 (10/10/17)

D Egg Dealers and Handlers Continued...

3. For all facilities built after January 1, 2012; I certify that:

The eggs and egg products are produced by commercial egg layer operations approved under

(or is convertible to) the American Humane Association facility system plan for enriched colony housing.

The eggs and egg products are produced by commercial egg layer operations that meet (or is convertible to the

standards identied in RCW 69.25.107).

With certain exceptions, the Washington Wholesome Eggs and Egg Products Act, Chapter 69.25 RCW, requires that

egg handler and egg dealer licensees provide proof that all eggs and egg products provided in intrastate commence are

produced by commercial egg layer operations whose existing facilities meet certain standards of the United Egg

Producer's 2010 Animal Husbandry Guidelines (web address below), and whose new facilities (built after January 1,

2012) meet or are convertible to the 2011 version of the American Humane Association system plan for enriched colony

housing (web address below). New facilities must also meet or be convertible to the standards identied in RCW

69.25.107. By completing, and returning this form you are certifying that your facility meets all of the

requirements in RCW 69.25.065. http://www.unitedegg.org/information/pdf/UEP_2010_Animal_Welfare_Guidelines.pdf