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i�7 I"�""l 1"''1 <br /> STAiC Ur CALOF PESTICIDE <br /> � ODUC SON AGRICULTURE IIAONTHLY PESTICIDE USE REPORT � <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PR-ENF-017C(REV.2199) <br />_!n�Muctions: Submit the white-conk to the Agricultural Commissioner within is days of month following application. <br /> MONTH 1 YEAR <br /> NURSERY 3 <br /> Page_Of <br /> OPERATOR IDIPERMIT NUMBER OPERAR(GROWER) ADDRESS CITY`A 2IP CODE <br /> 5ITtlffENTIFICATION NUMBER I TOTAL PLANTSD <br /> q�ACREAGE UNITS COUNTY NUMBER— SECTION TOWNSHIP RANGE BASE s MERIDIAN <br /> g 10 �/ III i2j 13 S 11 W 15 5 M H <br /> COMMODITY/SITE TREATED FIELD LOCATION <br /> 17 L 19 <br /> CHEMICAL EDIT IME ACREAOEAINrrS APP, SLOCKID 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) Of MEASURE) <br /> 21 22 f"] 23 24 ONE) 25 26 V 26 129 30 31 <br /> GA <br /> OTHER[] L OZ PT QT GA ! co lL-- <br /> AIR <br /> OTHER❑ 2-9r B OZ PT QT GA <br /> AI [ <br /> uR ❑ <br /> OTHER❑ =Zt LB OZ P OT GA c V <br /> OR Y <br /> 2� <br /> AIR ❑ l �, <br /> OTHER❑ _04 2{Z -ZILB OZ Q7 6A <br /> OTHER 3 { I �l' LB OZ CT QT0GA S \ a <br /> r.. <br /> OR ❑ <br /> AIR <br /> OTHER❑ LB OZ P7 QT GA <br /> OR ❑ <br /> AIR [] <br /> OTHER❑ LB OZ PT QT GA <br /> OR ❑ <br /> AIR ❑ <br /> OTHER LB OZ PT QT GAAIR <br /> OTHER❑ LB OZ PT QT GA „� s, <br /> .f <br /> OR <br /> NR ❑ a I n•V I:i e��i [i tj nn - <br /> OTHER❑ LB OZ PT OT GA i^L3 _3 <br /> OR ❑ <br /> AiR <br /> OTHER LB OZ PT OT GA <br /> OR <br /> OTHER❑ LB OZ PT QT GA <br /> OR <br /> AIR ' <br /> OTHER❑ LB _OZ PT O7 GA <br /> ❑ LB OZ PT QT GA <br /> ZIP� <br /> IEPORT PREPARED BY c DATE (�Q REVIEWED BY <br /> Distribution: White copy--CountyAgricultural Commissioner; Pink copy--DPR; Canary--Applicator, Goldenrod--Applicator FOR AGENCY UK ONLY <br />