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I r r I I I I I I I I I I I I I r I I <br /> STATE DEPARTMENT <br /> PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PR-ENF-017C(REV.WN) <br /> Instructions: Submit tMAI -2 <br /> o the Agricultural Commissioner within 10 days of month following application. <br /> TH 1 <br /> NURSERY 3 <br /> Page of <br /> OPERATOR ID/PERMIT NUMBER OPE:5R(GROWER) ADDRE 9 CITY BIP C DE <br /> .7U� ISIJ� B !cam 7 -%ice .3G <br /> SITE IDE TIF ATI N NUMBER' TOTAL PLA DACREAGE/UNITS COUNTY NUMBER SECTION TOWNSHIP RANGE BASE 6 MERIDIAN <br /> Aj N ^�E <br /> 9 ` 10 11 12 13 2 S 1 �Jyl W 15 S M H <br /> COM DITY/ ITE TREATED FIELD /I,��+�yy� <br /> 17 1e { `-' I� <br /> CHEMICAL DATE/TIME ACREMIENNRB APP. BLOCK IO EPA OR STATE REGISTRATION NUMBER TOTALPRODUCTUSED DAYS RATE DILUTION PRODUCT AND MANUFACTURER <br /> WOE NUMBER APPLICATION TREATED METHOD IIF (FROM LABEL) (CIRCLE ONE UNIT REENTRY PER ACRE <br /> COMPLETED (CHECK APPLICABLE) OF MEASURE) <br /> 21 22 23 24 ONE) 25 26 27 2B 2e 30 31 <br /> rX,(JJI�) GR n <br /> Wil <br /> LI OTHER❑ I'MR <br /> � F: �� ✓ L T GA <br /> OTHER❑ ` LB OZ PT OT GA E/✓� <br /> Gq ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> AIR <br /> OTHER LB OZ PT OT GA <br /> an ❑ <br /> NR <br /> OTHER H LB 02 Pi OT GA -RECEIV <br /> GR 8NR <br /> OTHER ❑ LB OZ PT OT GA <br /> GR ❑ <br /> MR11ER pJUL <br /> LB OZ PT OT GA <br /> GR ❑ <br /> MR <br /> OTHER LB OZ PT OT GA AGH.COMM,-W T CKTON <br /> OR ❑ <br /> NR <br /> OTHER H LB OZ PT OT GA <br /> GR ❑ <br /> MR ❑ <br /> OTHER p❑❑ LB OZ PT OT GAan <br /> OTHER❑ LB OZ PT OT GA <br /> GR 8 y <br /> an <br /> MR <br /> OTHER❑ LB OZ PT OT GAP MAA <br /> AR <br /> DHFR LB OZ PT OT GA <br /> GR i1N�f. :sttKpi�: Lot),LITHE LB OZ PT OT GA <br /> REPORT PREPARED BY -'d 0o REVIEWED BY <br /> Form Distribution: While c y--County Agricultural Commissioner; Pink copy--DPR; Canary--A,,. ator, G�damod--Applicator FOR AGENCY USE ONLY <br />