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Sample letter explaining annual written notification and individual application registry:
August 2013 The Healthy Schools Act of 2000/AB2260 contains the following procedures to control pests and minimize exposure of children, faculty, and staff to pesticides/herbicides: • Warning signs will be posted at all entrances to school district property 48 hours prior to regular
pesticide/herbicide applications and will remain posted for 72 hours after the application.
• Parents or guardians and staff may request in writing a separate written notice for each pesticide
/herbicide application 72 hours prior to the anticipated application. If you would like to be notified every time we apply a pesticide, please complete and return the form below and mail it to: Gerard Devitt Q.A.L. at Encinitas Union School District, 101 S. Rancho Santa Fe. Rd., Encinitas, CA 92024.
• Active ingredients of all pesticides/herbicides used by the Encinitas Union School District are listed
on the attached page. Additional information on these products and their alternatives may be obtained at the California Department of Pesticide regulation web site,
• The selection and use of the least hazardous methods and materials effective for the control of
targeted pests and weeds will be implemented.
• Non-chemical prevention of pest and weed population is always preferred using such methods as
sanitation, exclusion, and cultural practices.
• Precision targeting of pesticides and herbicides to areas not contacted by or accessible to
students, faculty, and staff will be implemented.
• Application of pesticides/herbicides will only be used “as needed” to correct verified problems. • In the event of an “emergency” application of a pesticide to control a specific and documented
problem, signs will be posted immediately and remain posted for 72 hours following the application procedure.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - REQUEST FOR INDIVIDUAL PESTICIDE APPLICATION NOTIFICATION I understand that, upon request, the school district is required to supply information about individual pesticide applications at least 72 hours before application. I would like to be notified before each pesticide application at this school. (Please print neatly) Name of Parent/Guardian: _________________________________ School____________________________ Address: _________________________________________________________________________________ Day Phone:(______)___________________________Evening Phone:(______)_________________________ E-mail: _______________________________________________ Date: ______________________________
ANNUAL NOTIFICATION OF PLANNED PESTICIDE USE
The Healthy Schools Act of 2000 requires all California school districts to notify parents and guardians
of pesticides they expect to apply during the year. We intend to use the following pesticides in your
school this year: Name of Pesticide
Active Ingredient(s) E.P.A. Reg. #
You can find more information regarding these pesticides and pesticide use reduction at the Department of Pesticide Regulation’s Web site at If you have any questions, please contact ENCINITAS UNION SCHOOL DISTRICT Gerard Devitt Q.A.L. at 760-944-4300 X1126
MATERIAL SAFETY DATA SHEET Section I - IDENTITY Common/Trade Name: Doxycycline for Injection, USP Chemical Names: 2-Napthacenecarboxamide,4-(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro- 3,5,10,12,12a-pentahydroxy-6-methyl-1,11-dioxo- Synonyms: Vibramycin Intravenous, Doxycycline, Liviatin, Doxiciclina, GS-3056 Manufacturer's Name: Address: Emergency Telephone Number:
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