Kentucky Office of the State Entomologist

Emerald Ash Borer State Compliance Agreement Application Form

Please fill out as completely as possible.

Remember to "TAB" or use your mouse to move between fields.
If you hit "ENTER" you will submit your data and have to start over!

If you have any question, contact Joe Collins

Your physical address where the regulated articles will be available for inspection:
(name, address, city, state, zip, county, phone number and fax number)

Name:
Address 1:
Address 2:
City, State, Zip:
County:
Phone:	Fax:
E-mail Address:

Your mailing address (if different from above):
(name, address, city, state, zip, county and phone number)

Name:
Address 1:
Address 2:
City, State, Zip:
County:
Phone:	Fax:
E-mail Address:

Destination of the regulated articles (City, State, County)?

List all regulated articles to be covered by the compliance agreement. Regulated articles include the emerald ash borer in any living state of development, firewood of all hardwood (non-coniferous) species, ash (Fraxinus spp) nursery stock, green (non-heat treated) ash lumber, other living, dead, cut or fallen material of the genus Fraxinus, including logs, stumps, roots, branches, and composted and uncomposted wood chips AND any other products, articles or means of conveyance of any character whatsoever, when it is determined by an inspector that the articles present a threat of artificial spread of the emerald ash borer and the person in possession thereof has been so notified.

How are you moving the regulated article(s)?:

Regulated materials accepted MUST receive ONE of the following treatments completed at owner's expense.
Remove the bark and an additional 1/2 inch of wood (Bark and wood removed regulated separately)
Follow a kiln sterilization treatment (The maximum thickness of allowable wood is three inches) See Attachment A-1.
Fumigate according to a treatment schedule. See Attachment A-1
Heat treatment. See Attachment A-1

Verification by telephone to (859) 257-5838 from you is required. This will allow us to make arrangements for the inspection.

No financial liability shall attach to the Commonwealth of Kentucky or to any officer or representative of the Commonwealth with respect to the compliance agreement.

Any intentional false statement in the compliance agreement or misrepresentation relative to the compliance agreement are subject to the monetary fines and penalties listed in the applicable quarantine(s), regulation(s) and law(s)

Name of Applicant:
Date: