Koi, Nishikigoi, water garden, watergarden, pond supplies, pond maintenance

Koi, Nishikigoi, water garden, watergarden, pond supplies, pond maintenance

Koi, Nishikigoi, water garden, watergarden, pond supplies, pond maintenance

Phone: (916) 373-0111
Fax: (916) 373-0411
September 09, 2010

Koi Enterprise: Drug and Chemical Waiver Form

Hire a persoanl Koi Shopper

Tiny Might Pumps

Drug & Chemical Purchases

The purchase and use of medications and chemicals by people within the aquaculture industry is a very sensitive issue. Federal and state agencies are concerned over the potential misuse of these items and the potential for diversion of these products to producers of aquaculture items intended for human consumption. We do not want to lose access to these valuable remedies and will do whatever we can to ensure that they will be used by all our customers and their employees only in the safe treatment of parasites and diseases on ornamental fish. Koi Enterprise will provide chemicals and drugs only to customers that certify they will control the use of these chemicals and will provide Koi Enterprise with the signed agreement below. Copies of invoices will be kept on file at Koi Enterprise. We strongly suggest that each customer prepare a log system to record the purchase and use of these items. This is to certify that the antibiotics and other medications purchased by me or any of my employees will be used only to maintain the health of ornamental fish. Both I and my employees are aware of the restrictions placed on the sale of these products and those people responsible for the treatment of our ornamental fish will be instructed in their proper use. We will not divert these chemicals to any other use and will establish and maintain written records of our purchase and use of these items.
First Name:
Last Name:
Address (Line 1):
Address (Line 2):	(Optional)
City:
State & Zip Code:
Area Code & Phone:
Email:
Confirm Email:
Date:

I hereby agree to the terms of this waiver form.

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3535 Partridge Ave
West Sacramento, CA 95691

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