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TATs o .77-.) ' L1FORNu X. PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT £PARTMENT OF PESTICIDE REGULATION R-ENF-017C(REV.2199) rrstructionsn: Submit the white conn to the Agricultural Commissioner within 14 days of month following application. ONTH 1 YEAR 2 NURSERY 3 Page_of_ PERAA�(TOR IDIPERMIT NUMBER (� OPERATOR(GROWER) ADDRESS �`S `\j CITY ZIP CODE S_23,,); JE IDENTIFICATION NUMBER TOTAL PLANTED ACREAGEIUNITS ICOUNTYNuMBEFL SECTION TOWNSHIP RANGE BASE&MERIDIAN 10 3 t 11 12 13 a S 14 y C W 15 5 M H OMMODITYISITE TREATED FIELD LOCATION 410 CHEMICAL DATEITIME ACREAGE/UNITS APP. BLOCK ID EPA OR STATE REGISTRATION NUMBER TOTAL PRODUCT USED DAYS MTB DILUTION PRODUCT AND MANUFACTURER ;ODE NUMBER APPLICATION TREATED METHOD (IF (FROM LABEL) iCIRCLEONEUNTT REENTRY PER ACRE COMPLETED (CHECK APPUCABifl OF MEASURE) 11 22 23 ONE) 5 26 27 29 29 Y 31 OTHER❑ �+ f � 7 � �J1��' f�6 L11� N LB O PT OT GA Alp 0 OTHER❑ LB OZ PT OT GA GR Ll AIR ❑ OTHER `,] LB OZ PT OT GA GR Q AIR ❑ OTHER❑ LB OZ PT OT GA GR Q AIR Q OTHER ❑ LB OZ PT CIT GA GR r] AIR (� OTHER ❑ LB OZ PT OT GA GR [] AIR Q OTHER Q LB OZ PT OT GA GR AIR ❑ OTHER [} LB OZ PT OT GA - GR [] AIR Q OTHER LB OZ PT OT GA GR Li AIR ❑ OTHER p LB OZ PT OT GA4 GR 0 •, AIR ❑ ,t OTHER Q LB OZ PT OT GA GR AIR S 's.. � _ OTHER❑ LB OZ PT CIT GA Abd 1,0 vi AIR ❑ OTHER❑ LB OZ PT OT GA GR Q AIR Q OTHER p LB OZ PT OT GA t % _ REPORT PREPARED BY „_,. L�. rya�k✓ € l,., �- (.01�� . DAT��Z-- �` Q � REVIEWED BY FOR AGENCY USE ONLY =erm Distribution: Waite copy--County Agricultural Commissioner; Pink copy--DPR; Canary--Applicator" Golden rod-Applicator