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7-1 ��.. -1.� �� i, -. .-1 ` 7-1 (ATE OF CALIFORNIA PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT j£PARTMENT OF PESTICIDE REGULATION PR-ENF-017C(REV.2189) Instructions: Submit the w conn to the Agricultural Commissioner within 10 days of month following application. MONTH 1 YEAR 2 I�I NURSERY 3 page of OPERATOR lO/PERMIT NUMBER "`� OPERATOR(GROWER) ADDRESS �q ` ', ry-�� } f� CITY ZIP CODE �7 4 ! 3 6 �'J W f VV�=i " 71a'r gC s✓ CC AN SITE IDENTIFICATION UMBER TOTAL PLANTED ACREAGE/UNITS COUNTY NUMBER SECTION TOWNSHIP RANGE BASE 8 MERi 9 �� 10 11 12 13 S 14 W 15 S OH COMMODITY/SITE TREATED FIELD LOCATION 1B f V�.,\ 17 OL2 CHEMICAL DATElrIME ACREAGEA1NrrS APP. BLOCK ID EPA OR STATE REGISTRATION NUMBER TOTAL PRODUCT USED DAYS RATE DILUTION PRODUCT AND MAXUFA CODE NUMBER APPLICATION TREATED METHOD (IF (FROM LABEL} (CIRCLE ONE UNIT REENTRY PER ACRE COMPLETED (CHECK APPLICABLE) OF MEASURE) 21 22 ;r� 23 24 ONE) 25 28 27 28 29 30 31 f R no OTHER❑ -/ LB OZ PT QT GAGA I v �0 AIR OTHER p i f LB OZ P GA GR at! AIR OTHER ID 8 OZ PT OT GA ' GR AIR OTHER LS OZ PT DT GA GR ❑ A1R OTHER LS OZ PT OT GA GA ❑ AIR ❑ OTHER ❑ LS OZ PT OT GA GR ❑ AIR ❑ OTHER❑ LB OZ PT OT GA GR AIR OTHER ❑ LB OZ PT QT GAOR 171 i At nh fI AIR ❑ �.. ?' ! f 5 OTHER❑ LB OZ P7 OT GA �' �,' GR ❑ AIR 0 OTHER❑ LB OZ PT QT GA R.E OR AIR OTHER❑ LB OZ PT OT GA GR ❑ AIR ❑ DHEA❑ L8 OZ PT 43 GA GR ❑ AIR ❑ OTHER❑ LB OZ PT OT GA �13311 AIR ❑ OTHER ❑ LB OZ PT OT GA I REPORT PREPARED BY DINA i K.A DATE REVIEWED BY \F ,rm Distrit;ufion: White copy--�aunty Agriculture Comrnissio er; Pink cop ; Canary--Applicator, Goldenrod--Applicator FOR AGENCY USE ONLY