AFFIRMATION OF STATUS
This affirmation is required by Section 6254.2 of the Government Code.
I have requested access to information submitted to the Department of Pesticide Regulation (or previously submitted to the Department of Food and Agriculture) by a pesticide applicant or registrant pursuant to the California Food and Agricultural Code. I hereby affirm all of the following statements:
I am aware that I may be subject to criminal penalties under Section 118 of the Penal Code if I make any statement of material facts knowing that the statement is false or if I willfully conceal any material fact.
Name of Requester | Name of Requester's Organization | |
Signature of Requester | Address of Requester | |
Date | Request No. | Telephone Number of Requester |
Name, Address, and Telephone Number of Requester's Client, if the requester has requested access to the information on behalf of someone other than the requester or the requester's organization listed above. |
For purposes of this subdivision, any contractor with the state who is furnished information pursuant to this section, or any employee of any contractor, shall be considered an employee of the state.
Ca. Gov. Code § 6254.2