Application for Registration of Liming Materials

GEORGIA DEPARTMENT OF AGRICULTURE 19 Martin Luther King Jr. Dr. SW, Atlanta, Georgia 30334-4201 Application For Registration Of Liming Materials Application is hereby made to register a liming material in the State of Georgia for the Fiscal year ending June 30, ______.

APPLICANT NAME DATE □ Individual □ Partnership □ Corporation BUSINESS NAME TYPE OF (if different) BUSINESS □ Legal Trust □ ______

ADDRESS CITY STATE ZIP

TELEPHONE NO. FAX NO. FEIN or SSN# □ Owner □ Partner AUTHORIZED SIGNATURE □ Corporate Officer ______Title

NAME (print) CONTACT PERSON (print)

Registration Fee - $70 per product. Tags, labels, or empty containers must be enclosed. Registrations expire each “June 30”, and must be renewed each fiscal year using the Application for Renewal of Liming Materials Registration form. A copy of this form will be returned for your records. APPLICATION FOR REGISTRATION IS MADE FOR: BRAND / PRODUCT NAME BRAND / PRODUCT NAME BRAND / PRODUCT NAME

Guaranteed Analysis Guaranteed Analysis Guaranteed Analysis Calcium Carbonate Calcium Carbonate Calcium Carbonate Equivalent (CCE) (Min) % Equivalent (CCE) (Min) % Equivalent (CCE) (Min) % Calcium (Ca) (Min) % Calcium (Ca) (Min) % Calcium (Ca) (Min) % Magnesium (Mg) (Min) % Magnesium (Mg) (Min) % Magnesium (Mg) (Min) % Passing 10 Mesh Sieve % Passing 10 Mesh Sieve % Passing 10 Mesh Sieve % 20 Mesh Sieve % 20 Mesh Sieve % 20 Mesh Sieve % 50 Mesh Sieve % 50 Mesh Sieve % 50 Mesh Sieve % 100 Mesh Sieve % 100 Mesh Sieve % 100 Mesh Sieve % 200 Mesh Sieve % 200 Mesh Sieve % 200 Mesh Sieve % Moisture (Max) % Moisture (Max) % Moisture (Max) %

Type: Dry □ Liquid/Suspension □ Type: Dry □ Liquid/Suspension □ Type: Dry □ Liquid/Suspension □ Dolomitic □ Calcitic □ Dolomitic □ Calcitic □ Dolomitic □ Calcitic □ FOR DEPARTMENTAL USE ONLY FOR DEPARTMENTAL USE ONLY FOR DEPARTMENTAL USE ONLY

REGISTRATION# REGISTRATION# REGISTRATION#

MAIL TO: Georgia Department of Agriculture, Seed, Fertilizer & Feed Section, 19 MLK Jr. Dr., SW, Atlanta, Georgia 30334-4201 FOR DEPARTMENTAL USE ONLY FOR DEPARTMENTAL USE ONLY FOR DEPARTMENTAL USE ONLY

Date: ______

Check #:______

Check $: ______

Company ID #:______BY______PROGRAM DIRECTOR

SFF-LIME REGISTRATION