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                          Statewide Pesticide Pick-Up

Operation Cleansweep is a mobile pesticide collection program that
provides a safe way to dispose of cancelled, suspended, and unusable
pesticides at no cost. Pesticide dealers can participate for a fee.

      Farms/Groves                     Pest Control Services              Forestry
      Nurseries                        Greenhouses                        Golf Courses

                                     FREE PICK–UP
                                We want your old pesticides.

      Cleansweep Partners and Representatives:                           For more information
   Florida Peanut Producers Association                                      CONTACT:
   Florida Turf Grass Association
   Florida Farm Bureau                                            Florida Department of Agriculture &
   Florida Fertilizer and Agrichemical Association                         Consumer Services
   Florida Fruit and Vegetable Association                 
   Florida Soybean Producers Association
   Certified Pest Control Operators                                        or call Toll-Free
   Florida Pest Management Association
   Florida Nursery, Growers & Landscape Association                      877-851-5285
   Florida Tomato Committee
   Florida Forestry Association                                     To arrange for a pickup
   IFAS/University of Florida
   Florida Citrus Mutual
                                                                     complete the Contact
   Florida Landscape Maintenance Association                       Information sheet below.
   Florida Department of Agriculture & Consumer Services         Email or Fax to (386) 418-5527
   Florida Department of Environmental Protection

      C L E A N S W E E P W E B S I T E :
                                          Revised Date 9/03/09
                            CONTACT INFORMATION

Have you ever participated in CleanSweep before?      Yes      No

Name of Firm:

Contact Person:

Contact Person Phone Number:

Email Address:

Fax Number:

Physical Address:

Additional Directions to Establishment:

Type of Firm:

   Farm              Nursery              Grove             Golf Course   Other

                                   Pest Control Company

                  Inventory (list products for each category):
            LIQUIDS (in gallons)          DRY MATERIAL (in pounds)

      Total Liquids:                         Total Dry Materials: