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'- PRO��ICTI )N AGRICULTURE MONTHLY PESTICIDE USER PART <br /> •�c of G�,Llru IA '~ ~` <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PR-EN F-017C(REV.2199) <br /> In ructions: Submit the white copy 0 the Agricultural Commissioner within 10 days of month following application, <br /> E i <br /> MONTH 1 YEAR 2 <br /> r <br /> NURSERY 3 <br /> Page-of� <br /> OPERATOR IDIPERMIT NUMBER OPERATOR{GROWER) ADDRESS /� CITY ZIP CODE <br /> `—� <br /> O 5 LJV 6 T` 1 �t—.-A/ 7 <br /> SITE IDENTIFICATION N MBER TOTAL PANTED ACRREE^A�J E1U ITS COUNTY NUMBER SECTION TOWNSHIP RANGE BASE MERIDIAN <br /> g <br /> 110 11 12 � 13 S 14 15 5 M H <br /> CCMMODITYlS1TETREATED FIELD LOCATION <br /> 17 6q-nps19 <br /> CHEMICAL DATEfFIME ACREAGEIUNITS Al 81 ID EPA OR STATE REGISTRATION NUMBER TOTAL PRODUCT USED DAYS RATE PER DILUTION PRODUCT AND MANUFACTURER <br /> CODE NUMBER APPLICATION TREATED METHOD (IF (FROM LABEL) (CIRCLE ONE UNIT REENTRY ACRE <br /> COMPLETED (CHECK APPLICABLE) OF MEASURE) <br /> 21 22 23 24 ONE} 25 26 27 28 29 30 31 <br /> 1 ORLOP� J <br /> AI RSR p Af OZ PT QT GA <br /> GR EJ <br /> l \ <br /> Z' OITHER LB OZ PT OT GA 5 J <br /> p� y clo <br /> AIR <br /> OTHER C:] <br /> f (� <br /> LB OZ �yPsTy�QT GA <br /> l {� •L.— AIR ❑ <br /> OTHER ❑ 6 OZ PT QT GA ` <br /> GR <br /> AIOTHER� -1% -?',l GA t\ <br /> i <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER ❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER ❑ LB OZ PT OT GA <br /> OR ❑ <br /> AIR 0 <br /> I OTHER C] LB OZ PT Of GA i`, .�•, •,,.„�. 4:'` <br /> I <br /> GR ElI <br /> AIR �] y y •� 5 e <br /> OTHER © LB OZ PT OT GA <br /> GR ❑ ¢l <br /> AIR <br /> OTHER ❑ LB OZ PT QT GA <br /> GR ❑ e :: t� <br /> AIR [] �.I,4 '•i,^ T <br /> OTHER❑ LB OZ PT QT GA <br /> GR p <br /> AIR ❑ K F �t [ F}C�t;a"` .N-,r <br /> OTHER Q LB OZ PT OT GA § <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB `OZZ PT CT GA <br /> REPORT PREPARED BY DATE f REVIEWED BY <br /> Form Distribution: White cc o nt A ricultu Commissioner; Pink co DPR; Cana A licator; Goldenrod--A licator FOR AGENCY USE ONLY <br /> PY Y 9 PY rY - PP PP <br />