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TMEN FPCSTIC VC RPQULAI IN <br /> j­n <br /> Instruct;oLn�ts: Submit the whit'eacop to the Agricultural Commissioner within 10 days of month following application. <br /> MO TI" Q 1 YEAR 2 <br /> NURSERY 3 - . Page_of <br /> OPERATOR ID/PERMIT NUMBER OPERATOR(GROWER) F. ADORE I_,, .c, .y f,q CITY 21 D5dn5 <br /> �- ► Ilea 3 =a, <br /> 5 0 <br /> SITE IDENTIFICATION NUMBER TOTAL PLANTEDACREAGE/UNITS COUNTY NUMB fl SECTION TOWNSHIP NOE ASE A MERIDIAN <br /> 1 I _ n/ IT -ter) N <br /> p I J I M 10 lM 11 12 v 73 I/ 14 15 S M H <br /> COMMODITY/SITE TREED FIELD LW ION _ q�\ <br /> / 'AV I,V/yW�\./Tp'� <br /> n 1c <br /> CHEMICAL TMIMiE ACREAOEIUNRB APP. BLOCKIU EPA OR STATE REGISTRATION NUMBER TOTAL PRODUCT USED MYB RATE DILUTION PRODUCT AND MANUFACTURER <br /> CODE NUMBER APPLICATION TREATED METHOD (If (FROM LABEL) (CIRCLEONEUNR REENTRY PER ACRE <br /> COMPLETED (CHECK APPLICABLE) Of MEASURE) <br /> 21 22 23 2A ONE) 25 261n I (�J� 2T 26 29 30 31 <br /> ox, ❑ � l 'J LB OZ PT OT OA O IL� FM <br /> O <br /> NR <br /> OTHER❑ LB OZ PT OT GA - <br /> GR ❑ <br /> NR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> an ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> AIR ❑ <br /> OTHER❑ LS OZ PT OT GA - <br /> OR <br /> AIR <br /> OVER ❑ LB OZ PT OT GA <br /> OR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR <br /> AIR p❑ <br /> OTHER ❑ LS OZ PT OT GA - <br /> OR Cl <br /> AIR p <br /> OTTER❑ LB OZ PT OT GA <br /> OR 0 <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> "_,�. 6 VE n <br /> OR <br /> AR <br /> OTHER p LB oz PT GT GA <br /> OR <br /> NR <br /> OTHER❑ LB OZ PT OT GA - 4D <br /> OR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> AIR ❑ �UIvII�. - J i ��✓(�I l7('� <br /> \/ OTHER❑ LB OZ <br /> �PT QT GA <br /> REPORT PREPARED BY V G� r�f �.� V�' DATE-11 R3��- REVIEWED BY <br /> Form Distribution: White copy--County Agricultuml Commissioner; Pc copy--DPR; Canery--AppllcatoF,, Goldeiimd--A plicator FOR AGENCY USE ONLY <br />