Noxious Weeds Application

Helping growers manage and control noxious weeds locally

Step 1 - Contact Information

First Name

Last Name

Phone

Street Address

Street Address Line 2

City

State

Postal / Zip code

Applicator Full Name

Location For Application

Private Applicator Number

Restricted Materials Permit Number/Operator ID

Recommendation from PCA Required

Uploaded using file button

Emailed to sjcrcdweeds@outlook.com

PCA Documentation

Upload File

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Noxious Weeds to be sprayed (Please list all)

Estimated Total Area to Spray

Estimated Cost per Application

Each additional treatment requires prior authorization for reimbursement.

Before Pictures Required

Uploaded using file button

Emailed to sjcrcdweeds@outlook.com

Upload File

Upload supported file (Max 15MB)

After Pictures*

I understand pictures must be emailed to sjcrcdweeds@outlook.com after treatment in order to recieve reimbursement.

Please check this box If you would like a SJCRCD representative to assist in taking the before/after pictures.

Receipt for materials purchased

Upload File

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Your Signature

Select a date required

I have read the following disclaimer:

I certify that the information included in this application is true and correct to the best of my knowledge.
I certify that all pesticide products were legally purchased, properly labeled, and used in accordance with label requirements and all applicable federal, state, and local pesticide use laws and regulations.
I certify all pesticide materials were used solely for the treatment of noxious weeds listed in CCR 4500 and consistent with the goals of CDFA’s 2023-2027 Noxious Weed Grant Program.
The applicant understands and acknowledges that reimbursement is contingent on receipt of all required documentation listed above, available grant funding, and approval by the RCD.

Thank you for your submission!