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I i I I I 1 I 1 1 I I L I i I II I i I <br /> STATE OF CALIFORNIA <br /> DEPARTMENT OF PESTICIDE REGULATION PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT <br /> PR-ENF•D17C(REV.WOO) <br /> Instructions: Submit the.white conn to the Agricultural Commissioner within,10 days of month following application. <br /> �f c1 -000 <br /> - <br /> MONTH i YEAR 2 <br /> NURSERY 3 <br /> Page-of <br /> OPERATORfIWPERMiT NUMBER <br /> OPERATOR(GROWER) ADDR''E__SJJS CITY ZIP COODE 7 <br /> 4 e / y�l r / , l 5fG �1 E)1, 6 L£�l tlC' 7 / B ! �/� <br /> SITE IDENTIFICATION NUMBER TOTAL PLANTED ACREAGPJUNITS COUNTY NUMBER SECTION TOWNSHIP RANGE BASE d MERIDIAN <br /> [,7 <br /> 9 �� 1❑ 11 12 13 S 14 W 15 S M H <br /> COMMODITYISIT/E TREATED CFIELD LOCATIONy� <br /> 17 0 ! C� S 19 1. t� L/rryw' -e 1W <br /> �j <br /> CNfMICAL DATEMME ACREAGEAINRS APP. BLOCK ID EPA OR STATE REGISTRATION NUMBER TOTAL PRODUCT USED DAYS RATE DILUTION PRODUCT AND MANUFACTURER <br /> CODE NUMBER APPLICATION TRFATEO METHOD (IF (FROM LABEL.) (CIRCLE ONE UNIT REENTRY PER ACRE <br /> COMPLETED (CHECK APPLICABLE) OF MEASURE) <br /> 21 22 23 24 ONE) 2s 2e 27 29 2e 130 3t <br /> © _ / , r <br /> OR <br /> i HER O (� L OZ PT OT GA <br /> OR ❑ <br /> NR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> ALR ❑ <br /> OTHER❑ LS OZ PT QT GA <br /> GR ❑ <br /> AIR <br /> OTHER ❑ LS OZ PT OT GA <br /> GR ❑ <br /> NR ❑ <br /> OTHER ❑ LB OZ PT OT GA <br /> GR ❑ <br /> ALR ❑ <br /> OTHER© LB OZ PT OT GA <br /> GR ❑ rl• _ _ <br /> AIR ❑ I` - <br /> OTHER❑ LS OZ PT OT GA <br /> 11 <br /> AAA <br /> GTHER H LB OZ PT OT GA <br /> GR ❑ ri r,' t. <br /> Alp ❑ ,; <br /> OTHER❑ LB OZ PT OT GA =' <br /> OR ❑ <br /> NR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR <br /> NR <br /> OTHER U LB OZ PT OT GA <br /> cFl ❑ <br /> AIR ❑ <br /> OTHER❑ LS OZ PT OT GA <br /> REPORT PREPARED BY_ DATE �f -? REVIEWED BY <br /> `-?Ia a Iii';{yjl:!.iFiO43: ?'HhiN roov- 'ounty;ky.ricuftLama l Commissioner; Pink cop)--DPR; Canr; FOR AGENCY USE ONLY <br />