Application for Sonoma County Agriculture Access Verification Card

SONOMA COUNTY SHERIFF / DEPARTMENT OF AGRICULTURE/WEIGHTS & MEASURES

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Instructions:

Thank you for your interest in the Agricultural Access Verification Card Program.

Your application will be reviewed in the order received. Once your application has been reviewed, you will receive a separate email notifying you of your application status (approved, denied, appointment needed, or on hold pending additional information) and additional instructions.

For information regarding the Agricultural Access Verification Card Program, including eligibility and authorization requirements, please visit https://sonomacounty.ca.gov/AWM/AgAccess.

Agricultural Operation

* = Required Field

Nature of Operation:

Commercial Plant Agriculture Producer

Commercial Livestock Producer

Proof of Eligibility Provided by Applicant:

Operator Identification number

Certified Producer Certificate

CDFA Organic Registration

Agricultural land lease documentation

IRS Schedule F

USDA FSA documentation

CDFA Bureau of Livestock Identification

While the Department of Agriculture/Weights & Measures accepts this form of Proof of Eligibility, the document(s) selected will need to be provided to Department staff for review and verification. Document(s) will be reviewed in person during a scheduled appointment and immediately returned to the applicant. Document(s) will not be kept on file by the Department.

Please complete and submit application and you will be contacted by Department staff to schedule an appointment.

Operator Identification number (Last six digits of ID number):

Certified Producer Certificate:

CDFA Organic Registration:

Critical & Essential Activities to be performed:

Irrigation

Livestock Care

Refueling

Support to First Responders

Harvest and Related Activities

Other

Other Critical & Essential Activities:

Primary Location (be as descriptive as possible, including, at minimum, an address):

Additional farm or ranch address 2:

Additional farm or ranch address 3:

Additional farm or ranch address 4:

Additional farm or ranch address 5:

Additional farm or ranch address 6:

Additional farm or ranch address 7:

Additional farm or ranch address 8:

Additional farm or ranch address 9:

Additional farm or ranch address 10:

Additional farm or ranch address 11:

Additional farm or ranch address 12:

Additional farm or ranch address 13:

Additional farm or ranch address 14:

Additional farm or ranch address 15:

Additional Information / Notes (if needed):

Owner/Applicant Information

Is Property Owner/Operator currently the subject of a CalOSHA investigation for alleged violations of workplace safety regulations?

Yes

No

Provide additional information about alleged violations of workplace safety labor regulation:

Is the Owner and Applicant the same person?

Yes

No

Property Owner/Operator/Business Name

Property Owner/Operator Phone Number

Property Owner/Operator Address

Applicant First Name

Applicant Last Name

Applicant Full Name

Email address of Applicant

Phone Number of Applicant

Address of Applicant

Applicant Title

Relationship of Applicant to Owner/Operator

Proof of Employment Provided by Applicant

Letter of Authorization

W-2 or Equivalent

Proof of Employment Upload (Letter of Authorization)

Training Certificate

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Agricultural Access Verification Card Program Application / Programa De Tarjeta de Verificación de A

Agricultural Operation

Owner/Applicant Information