Form 8570-4 Confidential Statement of Formula

Confidential Busines11 Information: Does Not Contain National Security Information IE. 0. 12065)

EPA

States

0MB No. 2070-NEW; Expiration Date: XX/XX/XXXX

Environmental Protection Agency

□

Washington, DC 20460

See Instructions on Back
Alternative Formulation

Office of Pesticide Programs (7505C) - Confidential Statement of Formula

1 . Name and Address of Applicant/Registrant (Include ZIP Code)

2. Name and Address of Producer (Include ZIP Code)

3. Product Name

4. Registration No./File Symbol

5. EPA Product Mgr/Team No.

6. Country Where Formulated

7. Pounds/Gal or Bulk Density

8. pH

9. Flash Point/Flame
Extension

EPA USE ONLY

10. Components in Formulation (List as
actually introduced into the formulation. Give
commonly accepted chemical name, trade
name, end GAS number.)

12. EPA Reg. No.

11. Supplier Name &
Address

13. Each Component
in Formulation
a. Amount

··-

b. % by
Weight

14. Certified limits%
by Weight
1. Upper

Limit

b. Lower

Limit

15.
Purpose ,n
Formulation

------

--·--·---

-

16. Typed Name of Approving Official
18. Signature of Approving Official

EPA Form 8570-4 (Rev. 8-941

*

U.S. OPO: 1996·388-820/20414

17. Total Weight
119. Title

100%

120. Phone No. (lnFile Typeapplication/pdfFile TitleEPA Form 8070- 4: Confidential Statement of FormulaSubjectPesticide Registration FormsAuthorUS EPA, Office of Pesticide ProgramsFile Modified2023-04-18File Created2023-01-04