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DEPARTMENT <br /> NTOF,PES I I I PHODuc F10N AGRICULTdHE M&THL4 PESTICIDE ISE REl"ORT <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PR.ENF-017C(REV.2/001 <br /> M50c(lons: Submit the wbitel� to the Agricultural Commissioner within 10 days of month following application. <br /> MONTH ll 1 YEART 2 <br /> NURSERY 3 <br /> Page of <br /> OPERATOR ID/PERMIT NUMW 7, ! S ERATOR�O�N��n I SOORESe 4W 30t_ .� ��G/L ITY /���� el yODE <br /> ���� <br /> SITE IDEDEMI,TTIIFIIC/RIO`NN NUMBER /—/j TOTALP TEOACRIE-AGE"ITS COUN NU ER Slio 111 ECTION If TOWNSHIP �� S PANG (IOW BSSEE&MERIDIAN <br /> H <br /> v 113 <br /> I IS <br /> COMMOOITY/SITE TREATED ,^v FIELD LOCATION U•�lLJ <br /> 17 �- Pc-� ,0 cT <br /> CHEMICAL DATE/TIME ACREAGPAINITS APP. SWCK0 EPA OR STATE REGISTMMON NUMBER TOTALPRODUCTUSED MYE RATE DAUTION PRODUCT AND MANUFACTURER <br /> CODE NUMBER APPLICATION TREATED METHOD (IF (FROM UBEU (CIRCLE ONE UNIT REENTRY PERACRE <br /> COMPLETED (CHECK APPUCASIE) OF MRABURE) <br /> 21 222 23 2t ONE) 26 26 /I py¢� 27 28 20 30 31 <br /> f D MER LA �ff /� LB P� OT GA ' <br /> OR <br /> AIR <br /> oTMER❑ LB OZ PT OT OA <br /> GA ❑ <br /> uR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> MR <br /> OTHER LB OZ PT OT GA <br /> GR ❑ <br /> MR <br /> OTHER H IS OZ PT OT GA <br /> GR 9MR <br /> OTHER❑ LB OZ PT OT GA <br /> OR 0 <br /> MR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR \kyr• , ' <br /> MR d T1 <br /> OTHER OZ PT OT GAOR 0 <br /> y :�,. 14 <br /> OTHER® OZ PT O7 GA <br /> f \ <br /> MR H <br /> OMER[I LB OZ PT 07 GAOR <br /> MR a ]A i'It*11 skN N`f•ii�., r .y.\ [.,;J+ -)\ <br /> OMER❑ ti-I�v d �avS Ep�e r4�q}Id1F rL OZ PT OT GA <br /> MR <br /> OMER❑ LS OZ P7 OT GA <br /> OR <br /> NR <br /> OTHER❑ LS OZ PT OT GA P� <br /> GR SMR <br /> OTHER❑ LB OZ PT OT GA <br /> REPORT PREPARED BY DATE REVIEWED BY <br /> Form Distribution: White copy--County Agrioultuml Commissioner, Pink copy--DPR; Canary--Applicator, Goldenrod--Applicator FOR AGENCY USE ONLY <br />