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717, °> CvLlrurlNlA PRODUCTION AGRICULTU MQNTHLY PESTICIDE USER ORT <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PR-ENF-017C(REV.2199( <br /> Instructions, Submit the white copy to the Agricultural Commissioner within 10 days of month following application.r <br /> MONTH 1 YEAR 2 �. <br /> NURSERY 3 y <br /> Page-of <br /> OPERATOR IDIPERMIT(�N.UMBER OPERATOR(GROWER) /{� ADDRESS + �( `,� �] CITY y � ZIP CODE <br /> SITE IDENTIFICATION NUMBER TOTAL PANTED ACREAG UN]TS COUNTY NUMBER SECTION TOWNSHIP RANGE BASE 8 MERIDIAN <br /> //�} 5 19 �� 1 5 S M} H <br /> CN <br /> 9 r 1 D Z/1__+° ill 112 ��„ �� <br /> COMMCDITYISIT(EETyREEATED FIELD LOCATION <br /> 17 1[.�7 \ 19 <br /> CHEMICAL DATE ME ACREAGEfUNITS APP, BLOCK ID EPA OR STATE REGISTRATION NUMBER TOTAL PRODUCT USED DAYS RATE PER DILUTION PRODUCT AND MANUFACTURER <br /> CODE NUMBER APPLICATION TREATED METHCD (IF (FROM LABEL) (CIRCLE ONE UNIT REENTRY ACRE <br /> COMPLETED (CI-iPCK APPLICABLE) OF MEASURE) <br /> ONE)21 22 23 24 25 26 27 28 29 30 31 <br /> 2� AIR <br /> OTHER OZ Z �- co <br /> PT QT GA <br /> GR 300 <br /> - <br /> � Z�/! OTHER p { � LB OZ PT <br /> QT GA <br /> GR <br /> AIR <br /> OTHER ❑ LB 0Z PT QT GA [ <br /> [� V/ AIR Elt'� 1 l: r �— <br /> I( 0111 OTHER ❑ \ 1. OZ PT OT GA l <br /> OR ❑ <br /> AIR ❑ <br /> OTHER ❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER ❑ LB OZ PT OT GA <br /> OR 0 <br /> AIR ❑ <br /> OTHER ❑ LB OZ PT QT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER C] LB OZ PT OT GA ,,:._1.4- =='; <br /> 1 Aye <br /> AR `5 �%Fay• ; <br /> OTH0 ❑ LB OZ PT QT GA VOWGR El <br /> AIR L] <br /> OTHER 0 LB OZ PT qT GA } <br /> GR ❑ <br /> AIR ❑ <br /> OTHER ❑ - LB OZ PT QT GA w �� <br /> elr r r-1 PN ,- tilt 1� <br /> GR Q gg?n�ry��k� � aQ�ggga-yyyy9 <br /> AIR ❑ Lc'��ji➢�8.�41;ve�YGN"11d'si�c <br /> OTHER ❑ LB OZ PT QT GA <br /> GR ❑ <br /> AIR [] <br /> OTHER{] LB OZ PT QT GA <br /> GR <br /> AIR <br /> OTHER ❑ LB OZ PT QT GA <br /> REPORT PREPARED BY ky 1 [Jtfr�LJ __ __ - DATE REVIEWED BY <br /> kirm Distribution: White co Count A ftuhrai Commissioner; Pink co DPR; Cana A iicator, Goldenrod--A ficator FOR AGENCY USE ONLY <br /> PY-- Y 9 PY-- Canary-- 4�P PP -- <br />