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STATE OP CALIFORNIA PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PR•ENF-41"C(REV.2199) <br /> Instructions: Submit the white to the Agricultural Commissioner within iQ days of month following application. <br /> MONTH 1 YEAR 2 <br /> NURSERY 3 Page_Of� <br /> OPERATOR IDIPERMIT NUMBER OPERATOR(GROWER) ADDRESS n CITY ZIP CODE <br /> 3 5 6 � IVIV 7 O� 8 <br /> 4 RANGE BASE k RIDIAN <br /> SITE IDE IFICATION NUM/ R TOTAL PLANTED R6AGE1 STS COUNTY NUMBER SECTION TOWNSHIP <br /> y `- 1 10 l 11 t2'V � <br /> 113 S 14 W 15 S H <br /> COMMODITYlS E TREATED FIELD LOCATION <br /> CHEMICAL DATEITIME ACREAGEIUNRS APP. BLACK ID EPA OR STATE REGISTRATION NUMBER TOTAL PRODUCT USED DAYS RATE DILUTION PRODUCT AND MANUFACTURER <br /> COCENUMBER APPLICATION TREATED METHOD (IF (FROM LABEL) (CIRCLE ONE UNIT REENTRY PERAGRE <br /> COMPLETED (CHECK APPLICABLE) OF MEASURE) <br /> _j <br /> ONE} 2.7 2$ 29 30 31 <br /> 21 22 23 24 25 2fi <br /> GR <br /> Zv OTHER 01 a q3s-�l3 a A L O PTOTGA <br /> ` <br /> GR <br /> G AIR ❑ ` <br /> OTHER❑ OZ PT OT GA <br /> GR \ 3(:)c t <br /> "'�fl AIR <br /> 0 AIR p Q/Z'PT OT GA <br /> //` AIR (9©d. /� e <br /> �^(O AIR ` r <br /> LDOTHER � OZ PT q7 GA <br /> / GR <br /> `��/ AIR <br /> OTHER❑ OZ PT OT GA <br /> AIR 30 L <br /> AIR ❑ L,'t <br /> OTHER ❑ (Lb OZ PT CIT GA <br /> GR [] <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR <br /> ❑ <br /> OTHER ❑ LB OZ PT OT GA <br /> AIR <br /> �y <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ �u <br /> OTHER❑ LB OZ PT OT GA y 61 <br /> GR ❑ �", i� w <br /> AIR <br /> OTHER p LB OZ PT OT GA ��5y 4 [ i S J <br /> ) <br /> GR ❑ y� N 30AIR <br /> Ll \J <br /> OTHER❑ LB OZ PT OT GA AGRIL 12DMLILODI <br /> GR {] <br /> AIR ❑ <br /> OTHER❑ LB OZ PT QT GA <br /> GA ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> R�PORT PREPARED BY DATE REVIEWED BY <br /> FOR AGENCY USE ONLY <br /> Form'Distritwtion: White coA-- u Agricul mmissioner, Pink copy--DPR; Canary--Applicator, Goldenrod--Applicator <br />