Laserfiche WebLink
1_._ TF CAI IA If 1 1 . .10d—TICk. ,iGFk-_JLTL : rd- . _ fHU ESI DEI ° R1 IRT) 'I I I <br /> DEPARTMENT OF PESTICIDE REGULATION _ <br /> PR-ENF-017P(REV.WN) <br /> instructionss:Submit the white the Agricultural Commissioner within 10 days of month following application. <br /> MONTH I YEAR 2 <br /> NURSERY 3 Page_of_ <br /> OPERATOR ID/PERMIT NUMBER I OPERATOR(GROWER) I ADDRESS .t ' CITY ; ZI CODE <br /> a - �— 5 6 3 B5d05 <br /> SITE IDENTIFICATION NUMMB{7ER TOTAL PLANTED A�REAGE/UpNITS COUNTY NUMBER SECTION TOWNSHIP ANGE ASE E MERIDIAN <br /> B 70 4 �"-'V 11 12 13 14 15 S M H <br /> COMMODITY/SITE <br /> �TR�EA�TED FIELD LF ION V v W k V <br /> ftAkL <br /> 17 l T + 'E 10 <br /> CHEMICAL pATFRIME ACREAOENNRB APP. BLOCK ID EPA OR STATE REOIBTMTION NUMBER TOTAL PRODUCT USED MYS RATE DILUTION PRODUCT AND MAHUFACNRER <br /> CODE NUMBER APPLICATION TREATED METHOD (IF (FROM LABEL) (CIRCLE ONE UNI REENTRY PER ACRE <br /> COMPLETED (CHECK APPNG Kn OFMEASURE) <br /> 21 22 23 24 ONE) 2528 77 ZS 28 30 31 <br /> 0 on <br /> R 24 OmER[I &Z PT OT OA Q (L�"""`� " / r <br /> oNRN ❑l <br /> MEN❑ LB OZ PT OT GA - <br /> OR ❑ <br /> AIR Cl <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> AIR <br /> OTHER LB OZ PT OT GA <br /> OR ❑ <br /> AIR <br /> OTHER B LB OZ PT OT GA <br /> OR <br /> MR <br /> OTHER ❑ LB OZ PT OT GA <br /> OR ❑ <br /> NR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> aR ❑ <br /> AIR <br /> OTHER e LS OZ PT OT GA <br /> DR g rp 3 41999 <br /> GR <br /> OTHER LB OZ PT OT GA L <br /> OR ❑ <br /> AIR p �1 <br /> OTHER❑ LB OZ PT OT GA AGR. U01" <br /> OR p 1 V <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR <br /> O 8 <br /> OTHER❑ LB OZ PT OT GA <br /> an <br /> AIR <br /> oTHER❑ LS OZ PT OT GA <br /> OR ❑ <br /> AIR ❑ <br /> / OTHERyn�❑ LS OZ PT OT GA <br /> \ <br /> REPORT PREPARED BY Y kLG r f1 Ic "' `�- ✓ ✓ DA Ct REVIEWED BY <br /> Form Distribution: White copy--County Agricultural Commissioner; P L copy--DPR; Canary--Appllcalo . Goldel rod--A plicator I FOR AGENCY USE ONLY <br />