2020 Strychnine Purchase & Use Application - WAITING LIST
Application to purchase and use Strychnine in Starland County
Email address *
Date *
Name (First and last) *
Phone *
Mailing Address (MUST Include town and postal code) *
Home Quarter Location *
Infestation Location *
Farm Size (acres) *
Estimate of areas to be treated
Crop (Acres) *
Forage (Acres) *
Pasture (Acres) *
Number of 250 ml BOTTLES of 2% LSC required (PLEASE NOTE - There is a limit of 1 case per farm. There are 24 bottles/case. You must put # of BOTTLES, not cases *
Infestation Level (%) *
Is there endangered species on property where LSC will be used? *
I agree to pay the amount of $276.00/case or $11.50/bottle to Starland County *
Acknowledge of Purchase and Use of Product Agreement
2% Liquid Strychnine Concentrate (PCP# 30433 Maxim/30434 Agrium)

Use to Control Richardson's Ground Squirrels

I have read the label and information bulletin for 2% LSC (PCP# 30433 and/or 30434) and hereby agree to all the terms and conditions stated in the registration. I also agree to collect and dispose of the poisoned carcasses as directed by the label.

I understand the 2% LSC is registered only for control of Richardson's Ground Squirrels. I agree I will not sell or give away any of the 2% LSC I receive. I agree that all opened unused 2% LSC is to be disposed of according to provincial guidelines or returned to Starland County Agricultural Service Board.

I agree to report incidences of not-target poisoning including number and species found with lab analysis results included where possible. I will also report the existence and location of any species at risk (i.e. burrowing owl and swift fox). Violation of any of the above terms and conditions will result in the purchaser forfeiting the right to purchase and future purchases of the 2% LSC.
Acknowledgement *
Never submit passwords through Google Forms.
This form was created inside of Starland County. Report Abuse