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• 'a _ l J /.__ 1.1 Fw, =fs' "771 i,y 1 C-71 <br /> 1 <br /> STATE DEPARTMENT <br /> PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT <br /> DEPARTMENT OF .2/99)IDE REGULATION <br /> PR-ENF•D17C(REV.2199} C <br /> Instructions: Submit the white-coon to the Agricultural Commissioner within 10 days of month following application. <br /> T-0 f,N 0.006( <br /> MONTH 1 YEAR 2 <br /> NURSERY 3 <br /> Page ___-- <br /> OPERATOR IID//PERMIT NUMBER OPERATOR(GROWER) ^ ADDRESS CITY ZIP CODE <br /> �.�` <br /> 43c'lJ N 7v is Rr V 6 7 e �.3 <br /> SITE IDENTIFICATION NUMBE TOTAL PLANTED ACREAGEIUNITS COUNTY NUMBER SECTION TOWNSHIP RANGE BASE&MERIDIAN <br /> 9 ✓� 10 11 12 13 5 14 W 15 5 H <br /> COMMODITYISITE TREATED FIELD LOCATION <br /> 17 19 <br /> CHEMICAL DATErnmE ACREAGEJUNITS APP. BLOCKID EPA OR STATE REGISTRATION NUMBER TOTAL PRODUCT USED DAYS RATE DILUTION PRODUCT AND MANUFACTURER <br /> CODE NUMBER APPLICATION TREATED METHOD (IF (FROM LABEL) (CIRCLE ONE UNIT REENTRY PER ACRE <br /> COMPLETED (CHECK APPLICABLE} OP MEASURE) <br /> 21 22 23 24 ONE) 25 26 27 3 (^� 28 29 30 31 <br /> AIR <br /> V ZO OTHER a/� \ P LR •OZ PT OT�v GA � ..�...- <br /> AI VV <br /> OTHER p Lk Oz PT OT GA <br /> OR <br /> > ) <br /> r , OTHER❑❑ L! OZ P OT GA <br /> DR ❑ � T <br /> AIR ❑ <br /> OTHER❑ LB OZ PT QT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR Q <br /> AIR ❑ <br /> OTHER ❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER ❑ I-B OZ PT OT GA <br /> OR ❑ <br /> AIR <br /> OTHER LB OZ PT QT GA <br /> GR Q <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GH ❑ <br /> AIR <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> MR L] <br /> OTHER Q LB OZ PT OT GA <br /> GR ❑ <br /> AIR [] <br /> OTHER I] LB OZ PT QT GA <br /> REPORT PREPARED BYDATE/ls°. REVIEWED BY _-- <br /> Form Distribution: White Copw County Agricultural Commis honer: Pin co : Canary A)pflcator, Goldenrod--ADDlicator FOR AGENCY USE ONLY <br />