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STATE DEPARTMENT <br /> PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PR-ENF-0ITC(REV.yeD) <br /> Instructions: Submit the white cony to the Agricultural Commissioner within 10 days of month following application. <br /> aids <br /> MONTH 1 YEAR 2 <br /> O NURSERY 3 <br /> Page_O1 <br /> OPERATOR UPERMIT NUMBER ) l OPER�A^TOR(GROWERI ADORES S, / 61TY ZIP CODE <br /> J <br /> 5 CAI?I-),4 0117e e `J `7 .j C T J (r'7-G c. � e z 13 <br /> SITEIDENTIFICATION NUMBER y TOTAL PLANTED ACREAGE/UNITS COUNTY NUMBER SECTION TOWNSHIP BASE A MERIDIAN <br /> B-,d-I 'O(�n10 AL 11 G 12 / 2a 13 S 14 / 15 S A H <br /> COMMODITY/SITE REATED FIELD LOCATION / <br /> OEtI(/� a m,it vo Sd £ s / w t t — H�`!l e L�aAA <br /> n C�C1L- I 1B""�Il� Al A'�e S OdG 1s,. S G Jt / <br /> CHEMICAL T"MV ACREAOENNnt APRSlOCK1D EPA OR STATE REGISTRATION NUMBER TOTALPRJWQ USED DAYS RATE DILUTION PRODUCT AND MANUFACTURER <br /> CODENUMBER APPLICATION TREATED ZOO IIP (FROM USED P'NOLE ONE UNIT REENTRY PERACRE <br /> COMPLETED (CHECK APPIICABLE) OF MEASURE) <br /> 1 22 23 24 ONE) 25 26 2731 <br /> 107 <br /> omen j I z-d d•'/ I DC7�Ui� LB 02 PT OT GAOFS AQ Z U <br /> � <br /> ON 8AN <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> NR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR <br /> NR <br /> OTHER IS OZ PT OT GA <br /> MR <br /> OT <br /> OTHER LB OZ PT OT GA <br /> OR <br /> AIR <br /> OTHER LB OZ PT OT GA <br /> GR ❑ <br /> NR ❑ <br /> OTHER❑ LS OZ PT OT GA <br /> OR ❑ <br /> NR <br /> OTHER LB CZ PT OT GA <br /> OR ❑ <br /> NR <br /> OTHER <br /> LB OZ PT OT GA <br /> a. <br /> NR ❑ <br /> OTHER❑ LB OZ PT OT GA 1 _ <br /> OR p <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA ' <br /> DR e N <br /> IF <br /> OTHER❑ LB OZ PT OT GA 9 <br /> ❑ LB OZ PT OT GA <br /> OR ❑ <br /> 0 ❑ <br /> LB OZ PT OT GA <br /> REPORT PREPARED BY DATE 3 - // .� REVIEWED BY <br /> Form Distribution; White copy--County,Agdcultura mmissionar; Pink copy-DPR; Canary--Applicator, Goldenrod--Applicator FOR AGENCY USE ONLY <br />