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DEPARWEIVT OF IDE REGULATION r <br /> PR-EMF-017CV� ,)Pagelof6 PRODUCTION AGRICULTURE �.,JHLY PESTICIDE USE REPORT H ` <br /> (13E 3 <br /> � N <br /> CD <br /> <9 \ <br /> C <br /> S—-nit to the Agricultural Commissioner within 1D days of the month fol lowing applleation. <br /> C <br /> �.e-h N <br /> m <br /> M--'h r Year <br /> [," tunser/ 3 m <br /> OIU 3tor IDIPermlt No Operator_(Grower) Address City Zip Code <br /> QLc <br /> 5 <br /> 5ii�ienuac�norf To.- I omTFffann Xlwies ruts �Goun(y_NUMGir­ Section TT(Ywrnship Range Base$M vidian <br /> 9 o S J ,0 11 _hJ 112 N ❑ S ,a E ❑ LV r� 5 r.9 [] }t LD <br /> Ct�„noditylSlte Treated Field Location �2 <br /> w <br /> N <br /> S „ w t" u c 1Zc N <br /> OD <br /> —e/Time Acreage! Application Method Block IDEPA or State Registration Number <br /> 6-dicatfon Units (Check One) , (if (From label) Total Product Used Rate <br /> esnylry Per Acre Oilulion ?roduct and Manufacturer <br /> 18tgnpleted J9 Treated 20 Applicable 23 <br /> f� 24 25 27 <br /> 3ro <br /> Air and V <br /> ❑Fume _ ❑ 1:1 El ❑ '�'`�6/ <br /> � v i <br /> Other <br /> LB OZ PT QT GA <br /> ,Ground (r <br /> ❑Air O <br /> oOther B ❑ PT OT GAh rl�r� �v � l� o <br /> d <br /> Ground 2 ' <br /> Air 3 �/7- ' c/ L/ 2,LJ <br /> ,l <br /> ❑Fume j 1:1 ❑ ❑ ❑ <br /> _ <br /> E]Other ( J - ( L J LB OZ QT GA <br /> Ground <br /> / <br /> 3 6 E]Fume 60 3 1 El EJ ❑ ❑ q/7 40� 1'rr 1�Jf qP1 <br /> El other V V LB OZ PT QT GA <br /> r\JrUU13U <br /> Air <br /> Fume ❑ ❑ ❑ El El Other LB OZ PT QT GA <br /> Ground O 9,`V <br /> EAir <br /> ❑FuOthel ❑ ❑ ❑ ❑ ❑L13 OZ PT aT GA t M28NN ' <br /> D <br /> Report PWared By i Dale ReviewJAH ,l�Ai IJI� CDJ�STY n' <br /> CRfC' C�t,tiA� L C)DI <br /> For Agency Use Only s <br /> (1)GAC <br />