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STAIEG-CALIFORPJ <br /> DEPARTMEt-T OF-, A DE REGULATION <br /> iF-017C(REV. 08W)Page t of PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT 39'6474 <br /> CD <br /> m <br /> at tit to the Agricultural Commissioner within 10 days of the month fol lowing application. <br /> Q N <br /> �7 09 <br /> C71Cn <br /> IAr� t I Yea 2 <br /> T;ursery 3 m <br /> DF for IlDiPeerrmit No. Opera ( rower) Address City Zip Code <br /> E 4- <br /> Sit [daniification No. Total Planted Acr"Units County Number Section Township Range Base&Meridian N <br /> o ❑ m <br /> Io t� J tz c3 N ❑ S is E ❑ t�❑ 5 �M H S <br /> W <br /> ,ommodity/Site Treated Field Location o' <br /> I6 ryr 17 /. - _f-L+1/ ON <br /> `. O <br /> I—Mme AcreagaJ Application tiiethod Block ID EPA or State RegisUaUon Number 00 <br /> A�ication Units (Check One) 21 (If (From Label) Total Product Used Reentry Per Acre Dilution Product and Manufacturer <br /> jaC;pleted 19 Treated Z0 _ Applicable 22 23 24 25 126 27 <br /> round <br /> I ! Other LB OZ PT QT GA <br /> —7 Ground ` <br /> ❑Air zee 3 944 <br /> ❑Fume / -/ _ D <br /> [ <br /> Other B 1:1 11OZ PT 1:1QT G d <br /> Ground ~ <br /> ❑ <br /> Air <br /> ❑Fume ❑ ❑ ❑ ❑ ❑ <br /> ❑Other LB OZ PT QT GA <br /> Ground <br /> ❑Air <br /> [],Fume- ❑ I❑ ❑ ❑ ❑ <br /> Ground <br /> ❑Fume_ — ❑ I7] ❑ ❑ ❑ ,,,. r } <br /> ❑Other LB OZ PT QT GA '� 'lam' 11vu, <br /> Ground <br /> ❑Air <br /> Fume ❑ ❑ ❑ ❑ ❑ <br /> Other LB OZ PT QT GA <br /> L> <br /> f,7 <br /> / m <br /> Report Prepared By Date `� ',_-,/ 4C Reviewed By <br /> For Agency Use OnlyC0 <br /> d <br /> 1)CAC <br />