The MONTHLY SUMMARY PESTICIDE USE REPORT shown below is the form most likely to be used by a County department to report pesticide use. The reverse side of the form (shown on the following page) has instructions on how to complete the Report.   Completed forms are due by the 10th day of the following month. They can be mailed to:

ACWM –Pesticide Use Division
12300 Lower Azusa Road, Arcadia Ca 91006

Or faxed to ACWM: (626) 443-6652

The forms are available at ACWM’s Pesticide Regulatory Division is available to answer questions about the form. They can be reached at (626) 575-6466.

image of Pesticide Use Form (front)

Pesticide Use Form (back)