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I_ _ JF CAI IIA 1 I 1 , ,10d__TICI. _ .1GF1-- JLTI_ -: M fHU ESI DEl = RI- tRTI 1 1 1 1 <br /> DEPARTMENT OF PESTICIDE REGULATION - - <br /> PR-ENF-017P(REV.WN) <br /> InnsstrruccttJionnss: Submit the white cop-- to the Agricultural Commissioner within 10 days of month following application. <br /> AAA N <br /> MOM H 9 �- 1 YEAR 2 <br /> NURSERY 3 <br /> Page_of <br /> OPERATOR IDIFERMIT NUMBER I OPERATOR tGROWER) .I ADDRESS CITY ZI C0 J <br /> HUE <br /> V I I l x iJ_ <br /> 6 B ! 7 B <br /> SITE IDENTIFICATION NUMBER TOTAL PLANTED AGREAGE/UNITS COUNTY NUMBER SECTIONTOWNSHIP NGE A MERIDIAN <br /> kNy <br /> B 10 4 J/1 12 13 14 'VASE6 S M H <br /> COMMODITYISITETE T�O FIELD LOCATION - <br /> 11 10 �� (l/•L/l �I•l 1UIG/IV/rl/�I <br /> CHEMICAL DATE/TIME ACREAGENNRB APP. BLOCK ID EPA OR STATE REGISTRATION NUMBER TOTALPRODUCTUSED DAYS MTE DILUTION PRODUCT AND MANUFACTURES <br /> WOE NUMBER APPLICATION TREATED METHOD (IF (FROM LABEL) (CIRCLEONEUNR REENTRY PERACRE <br /> COMPLETED (CHECK APPLICABLE) OF MEASURE) <br /> 21 22 23 21 ONE) 2528 27 28 20 30 31 <br /> 1 OF <br /> t A IL� <br /> 1 J �-+�OTHER❑ � ( ` � �'J l./ LB Z PT OT GA O II' d.Ql�7, . �_ <br /> OR ❑ <br /> MR ❑ <br /> OTHER❑ LB 0E PT DT GA <br /> OR ❑ <br /> MR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> MR <br /> OTHER® LB OZ PT OT GA <br /> OR <br /> AIR <br /> OVER LB OZ PT OT GA - <br /> GR <br /> MR <br /> OTHER p LB OZ PT OT GA <br /> OR ❑ <br /> MR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> an ❑ LBO <br /> ^py° Q,msx <br /> OTHER 8 LB OZ PT OT GA 's <br /> OR ❑ �p 3 01999 <br /> MR ❑ <br /> OTHER❑ LB OZ PT OT GA L <br /> on <br /> MR <br /> OTHER❑ LB OZ PT OT GA AGR. 9� • <br /> GR <br /> /'tV:R. 1 iV <br /> MR 8 <br /> OTHER❑ LB OZ PT OT GA <br /> ORMR <br /> p❑ <br /> ONES❑ LB OZ PT OT GA <br /> OR <br /> AIR <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> NR ❑ <br /> \ GNERyn❑ LB OZ PT OT GA - - <br /> REPORT PREPARED BY V/ C' r r `0 r�c �- V Y ' DATE REVIEWED BY <br /> Form Distribution: White copy--County Agricultural Commissioner; P L copy--DPR; Caner y--Appllcato , GDlde rod--A)plimtot FOR AGENCY USE ONLY <br />