Weed-Free Gravel Inspection Request Form

ALASKA WEED FREE CERTIFICATION PROGRAM
Gravel Inspection Request Form
Statewide Program Contact:
Division of Agriculture
Plant Materials Center
5310 S. Bodenburg Spur
Palmer, AK 99645
(907) 745-8721 | Fax: (907) 746-1568
Local Contact:
Homer Soil and Water Conservation District
Producer/Operator
Phone
Address

Street Address

Street Address Line 2

CityState

Zip Code
Pit Location
Acres for inspection
Material description: Sand/Gravel/Rock/Top soil
Date Inspection Requested

MonthDayYear
Date

I/We intend to participate in the Weed Free Gravel Certification Program and request an inspection of the following material sites:

Please attach a detailed sketch and/or map showing sites to be inspected (or email to katrina@homerswcd.org)

Cancelof
Operator Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Gravel Inspection Request Form