SU0004715 SSNL - Laserfiche WebLink

Home Browse Search

I I 1 I I I 1 1 I l l I I I I I i 1 I STADEP RTMENE OF OF PE IA PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT DEPARTMENT OF PESTICIDE REGULATION PR-ENF-O17C(REV,2199) Instructions: Submit the White Cop to the Agricultural Commissioner within 10 days of month following application. MONTH 1 YEAR 2 NUR ERY 3 OPERATOR ID/PERMIT NUMBER OPERATOR(GROWER) ADDRESS Page_of CITY ZIP CODE 4 ��d'�'l�� +��T"�i�� 5 - -�i!(� � ��f B Y/`7>?iC.' L.• �. /�/ �� 7 SITE IDENTIFICATION NUMBER TOTAL PLANTED ACREAGEIUNI'TS COUNTYNUMBER SECTION �JTOWNSHIP RANGE �BASE&MERIDIAN 9 z � 10 �(::> 11 --:3! 12 13 J" S 14 i5 S H COMMODITYISITE TREATED FIELD LOCATION }� 17 18 CHEMICAL OATErnME ACREAGEA+NfrS APP- BLOCK ID EPA OR STATE REGISTRATION NUMBER TOTAL PRODUCT USED DAYS .RATE DILUTION PRODUCT AND MANUFACTURER CODE NUMBER APPLICATION TREATED METHOD (IF (FROM LABEL) (CIRCLE ONE UNIT REENTRY PER ACRE COMPLETED (CHECK APPUCABLE) OFMEASURE) 21 22 23 24 ONE) 25 26 27 28 29 30 31 GR AIR _ /JJ_ OTHER[] � /T/fXl f`J�/ (1�bCIT PT OT GA GR ❑ MR ❑ OTHER❑ LS OZ PT OT GA GR 0 AIR ❑ OTHER❑ LB OZ PT OT GA GR ❑ AIR OTHER H LB OZ PT OT GA GR ❑ AIR ❑ OTHER❑ LB OZ PT OT GA GA Ala OTHER❑ LB OZ PT OT GA GR ❑ AIR Cl OTHER❑ LB OZ PT OT GA - OR ❑ AIR OTHER LB OZ PT OT GA - AIR OTHER g LB OZ PT OT GA GR ❑ AIR ❑ OTHER❑ LB OZ PT OT GA GR ❑ AIR [] OTHER❑ LB OZ PT OT GA GR gAIR OTHER❑❑ LB OZ PT OT OA AI ❑ NR OTHER[7 LB OZ PT OT GA GR ❑ AIR 0 OTHER 0 LB OZ PT OT GA gEPORT PREPARED BY � DATE REVIEWED BY oI y�i_irihl.11icl�: !.1+f1iv3 rop; :ClunW Agricultural Commissioner; Pin!:roplr--DPR; Coneve--Applu:a@ar; t ^nrar9--: ^'ic FOR AGENCY USE ONLY