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SIAIaOF TMENT OF PES I I 1 PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT 1 1 f 1 t <br /> rh DEPARTMENT OF PESTICIDE REGULATION <br /> PR-ENF-017C(REV.LM) <br /> Instructions: Submit the white cop v to the Agricultural Commissioner within 10 days of month following application. <br /> MONTH 4e Z 1 YEAR 2 <br /> NURSERY 3 <br /> pageFI <br /> DI <br /> VVJ JA <br /> OPERATOR02/ <br /> /PERMIT F5P ' )t'V E� 1 ' 6 /fj]E(/may <br /> D/ C J `--� "'•A! 71ry31� O" E/ <br /> SITE IDENTIFICATION NUM330 ER V TOTAL PLANTED ACREAGENNITSC NTY N/U�M/BER SECTION TOWNSHIP RANGE BASE E MERIDIAN <br /> S '�� 10 11 12 / 13 S I M W 13 8 M H <br /> COMMODITY/SITE TREATED FIELD LOCATION <br /> l <br /> 17 <br /> CNEMICAL DAT"ME ACREAGEMNITS APP. IROCK0 EPA OR STATE REGISTRATION MUMSER TOTAL PRODUCT USED DAY! RATE DILUTION PR DUCT AND MANUFACTURER <br /> CODENUMBER APPLICATION TREATED METHOD OF (FROM NEL) (CIRCLE ONE UNIT REENTRY PERACRE <br /> COMPLETED (CHECK APPUCM" OFMEASURE) <br /> 21 2E2p/ Q 23 24ONE) 25 26 (' 27 28 129 SD 31 <br /> OTHER❑MR <br /> J LB P7 OT OA E � •C/� <br /> OR ❑ <br /> T <br /> OM ❑ <br /> !/ �� <br /> ER❑ 7 LB OZ PT OT OA <br /> OR ❑ <br /> AR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> MR ❑ <br /> OTHER❑ LB OZ PT OT OR <br /> OR <br /> MR 8 <br /> ODIER LB OZ PT OT GA <br /> OR <br /> OTHERMR <br /> LB OZ PT OT GA <br /> OR ❑ <br /> MR ❑ <br /> OTHER❑ LB OZ PT OT OR <br /> MR <br /> OTHER LB OZ PT OT GA <br /> OR <br /> MR <br /> OTHER LB OZ PT OT GA <br /> OR ❑ <br /> OMR 0 <br /> THER O <br /> LB OZ PT OT GA �st4'y I II <br /> GIR eMR <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ J <br /> MR ❑ <br /> OTHER❑ LB OZ PT OT GAOR <br /> MR !!�� ,l �11 <br /> OTHER p LB OZ PT OT GA A'CJI. COMM.IY M ' S T OGKI l)1 V <br /> GR gMR <br /> LB OZ PT OT OR <br /> i <br /> REPORT PREPARED BV DATE ` REVIEWED BY <br /> Fotm Distribution: White c y--County AgricuitkKi Commissioner, Pink copy--DPR; Canary--Appli tor, Goldenrod--Applicator FOR AGENCY USE ONLY <br />