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I i I I i 1 i 1 1 i 1 1 1 1 1 1 1 1 1 <br /> STATE OFPNIA <br /> DEPARTMENTNT OF PESTICIDE REGULATION PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT <br /> OF <br /> PR-ENF-017C(REV.2199) <br /> Instructions: Submit the white rM to the Agricultural Commissioner within 10 days of month following application. <br /> •I Q ( = <br /> MONTH 1 YEAR 2 <br /> NURSERY 3 <br /> Page o} <br /> OPERATOR 0PERMIT NUMBER OPERATOR{GROWER) ADDRESS CITY ZIP CODE <br /> SITE IDENTIFICATION NUMBER TOTAL PLANTED ACREA UNITS COUNTY NUMBER SECTION TOWNSHIP FLANGE BASE A MERIDIAN <br /> 9 �� 10 � 11 c 12 � 13 414 W 16 S M H <br /> COMMODITY/SITE TREATED FIELD LOCATION <br /> 17 1C �, 'I fC�, 19 <br /> CHEMICAL DATEMME ACREAGEJIINITS APP. BLOCK ID EPA OR STATE REGISTRATION NUMBER TOTALPRODUCT USED DAYS RATE DILUTION PRODUCT AND MANUFACTURER <br /> CODE NUMBER APPLICATION TRFATED METHOD (IF (FROM LABEL) (CIRCLE ONE UNIT REENTRY pER ACRE <br /> COMPLETED (CHECK APPLICABLE) OF MEASURE) <br /> 21 22 23 24 ONE) 25 26 27 28 29 30 31 <br /> M _ <br /> OTHER 01 � PT OT GA <br /> GR Cl <br /> Mi ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR El <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR <br /> OTHER H LB OZ PT OT GA <br /> GR ❑ <br /> AIR <br /> OTHER LB OZ PT OT GA <br /> OR ❑ <br /> AIR ❑ <br /> OTHER ❑ LB OZ PT OT GA <br /> OR <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ f <br /> OTHER❑ LB 02 P7 OT GA ( 1' ; <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LS OZ PT OT GA <br /> GR ❑ <br /> AR 0 <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> AR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> MR ❑ <br /> OTHER❑ LH OZ PT OT GA <br /> GR gAR <br /> OTHER❑ LB OZ PT OT GA <br /> GA ❑ <br /> AR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> REPORT PREPARED BY_ �� ��'�= Cil DATE �'� -ZO(12 r) REVIEWED BY <br /> :�li;� I I PP{E,l esinl�- 4�!EI1i1���o(� - ,a+_I rlb���gli�:ul4LaI I Commission Fir; Pinlc ro P;r--ni�¢i; C;�n�nr-�",p;,4;r,�1at; c sca�nf,�,:1...����,lir�.��+,." FOR AGENCY USE ONLY <br />