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y�OF�.AL�NIA --�_ � � �� l i !� <br /> DEPARTMENT OF PESTICIDE REGULATION PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT <br /> PR-ENF-017C(REV.2799) <br /> Instructions: Submit the white copy to the Agricultural Commissioner within 90 days of month following application. x <br /> MONTH 1 YEAR 2 <br /> I _ NURSERY 3 <br /> Paye—of <br /> OPERATOR IDIPERMIT NUMBER �'] OPERATOR(GROWER) ADDRESS CITY ` ZIP CODE <br /> 4 l� 5 l 6 i� 7 Cc® 5 1 -�� <br /> SITE IDENTIFICATION NUMBER TOTAL PANTED <br /> {ACC,REAGEIU ITS COUNTY NUMBER SECTION TOWNSHIP RANGE _ BASE&MERIDIAN <br /> 9 10 '(� 11 112 '3� 13 S'14 W 15 S H <br /> COMMODI7YISI7E 7REA ED FIELD LOCATION <br /> 17 L 19 Tu. L�/� <br /> � 1J- <br /> CHEMICAL bATETrIME ACREAGEMNITS APP. BLOCK 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 ONEy25 26 27 28 29 30 31 <br /> OTHER❑ f f OZ PT OT GAAIR <br /> .. <br /> GR <br /> V- Z-z— l OTr+ER❑ ( Z PT QT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER ❑ LB OZ PT QT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER ❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT QT GA <br /> Gil ❑ <br /> AIR Cl <br /> OTHER ❑ LB OZ PT QT GA <br /> OR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT QT GA <br /> GR ❑ <br /> AIR <br /> OTHER❑ LB OZ PT QT GAGR <br /> I <br /> AIA [] �ggt `p" ` • <br /> OTHER ❑ LB OZ PT OT GA <br /> OR ❑ <br /> AIR ❑ j*.!Y <br /> OTHER[� LB OZ PT QT GA ry `i A ;,,�� <br /> AIR OR ❑❑ `''�� Jv.1'V`k%�kJR C' �. <br /> p qq �,. <br /> OTHER [] LB OZ PT OT GAS ` � bd�1yyA <br /> GR ❑ � .YAgg1699Ve v lE. ii_ i <br /> AIR Li <br /> OTHER❑ LB OZ PT QT GA <br /> GA 0 <br /> AIR ❑ <br /> O1HLR ❑ LB OZ PT OT GA <br /> GR EJAIR ❑ <br /> OTHER❑ LB OZ PT QT GA <br /> REPORT PREPARED BY DATE REVIEWED BY <br /> FOR AGENCY USE ONLY <br /> Fmm Distribution: White copy--County Agricultural Commissioner; Pink copy--DPR; Canary--Applicator; Goldenrod--Applicator <br />