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STATE OF CALiFO <br /> DEPARTMENT OF F BICE REGULATION <br /> �Pi-�—dF-017C(REV.o8ra8)Pagel of PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT 3 9"j 4 5 7 m <br /> n � <br /> CS) <br /> S nit to the Agricultural Commissioner within 10 days of the manth following appitcation. `Lo <br /> Q I N <br /> N <br /> tJ1 <br /> M3 h Year 2 <br /> DTursefy 3 m <br /> zOf.—der IDiPerrnit No- Operat r Grower) �I Address City Zip Code LD <br /> Site Identhrcation No Total Planted Acres[Units County Number Section Township Range Base&Merldan ry <br /> o / f CirN El SE ❑W 9 rbrM ❑ H m <br /> 8 � 10 ! 11 12 113 Q td 1 ��-I co <br /> CooditylSite Trealed Field Locn alioW <br /> ii o <br /> ctPC P l o C N <br /> {Wf(me AcrzRate co <br /> age/ plication tutethod Block ID EPA or Stale Registration Number <br /> plication Units (Check One) 21 (if (From Label) Total Product Used Reentry Per Acre Dilution Product and Manufacturer <br /> jBCz plated 19 Treated 120 Applicable; 23 24 25 27 <br /> round <br /> Air 3 S 8-0 �( (��It L< r <br /> �Joo I y ❑Fumy <br /> _ �{'� ElEl ❑ ❑ r f �./ <br /> VV ! ❑Other , / 3 B OZ PT QT GA / G' j c•( (C <br /> round y:_ <br /> �7 <br /> tir <br /> ❑Fume _ L(3 11 El 1-1 1:1t I( (l 1 <br /> �r ❑Other �� S_,� Q LB OZ PT QT GA d <br /> Ground ~ <br /> ❑Air D <br /> ❑Furne ❑ ❑ ❑ ❑ ❑ <br /> ❑Other LB OZ PT 07 GA <br /> Ground <br /> ❑Air �� <br /> ❑Fume Cl ❑ ❑ ❑ ❑ } s► ,9 `t1 <br /> i—i na ' <br /> Groundxi <br /> ❑Air = 3or ASA.I Cl <br /> ❑Fume-- ❑ ❑ ❑ ❑ ❑ ` c0W <br /> ❑Other LB OZ PT QT GA <br /> ❑Ground <br /> Alf <br /> Fume ❑ El ❑ ❑ ❑ <br /> ❑Other LB OZ PT QT GA <br /> D <br /> G) <br /> m <br /> Report Prepared By Date /_ 1 7 r Reviewed By <br /> For Agency Use Only <br /> m <br /> 1)CAC <br />