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I I I r r r r r r r r r r r r r I I I <br /> STATE DEPARTMENT <br /> PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PR-ENF-017C(REV.WN) <br /> Instructions: Submit the white cop v to the Agricultural Commissioner within 10 days of month following application. <br /> MONTjl 1 YEAR . <br /> O NURSERY 3 <br /> Page/_of <br /> OPERATOR ID/PERMIT NUMBER OPERA/TOR(G7R/O/AW{EwR�) / ` / ADDRESS � � LIT ZIP CODE <br /> SITE IDENTIFICATION NUMBER TOTAL PLANTEDACREAGE/UNITS COUNTY NUMBER SECTION TOWNSHIP RANGE--P <br /> AN/G�E,.�N^' BASE B MERIDIAN <br /> {T Q� 2 N W E <br /> p J-� 10 11 12 13 (_/_J S 14 15 S M H <br /> COM ODITY/ ITE TREA D FIELD LOCATIO <br /> 17 /8 <br /> CHEMICAL DATE/TIME ACREAGE/UNITS APP. BLOCKID EPA OR STATE REGISTRATION NUMBER TOTALPRODUCTUSED DAYS RATE DILUTION PRODUCT AND MANUFACTURER <br /> CODE NUMBER APPLICATION TREATED METHOD (IF (FROM LABEL) (CIRCLEONEUNR REENTRY PER ACRE 1 <br /> COMPLETED (CHECK APPLICABLE) OF MEA SURE) <br /> 21 22 23 24 ONE) 25 26 27 20 29 JO 31 <br /> .O l.D� <br /> 3Q �V OTHER❑ �}I O PT OT GA <br /> �o A o <br /> /i�/ DRIER❑ LB OZ PT OT GA <br /> d q 3v d V MR 1:11 <br /> MER sv GA <br /> OR ❑ <br /> AIR <br /> OTHER LB OZ PT OT GA <br /> OR <br /> AIR <br /> B OZ OT GA O <br /> OR <br /> AIR ❑ <br /> Q 'l OTHER ❑ LB OZ PT OT GA <br /> OTHER p � LB O�GT G / 7 <br /> ❑ <br /> MR <br /> OMER LB OZ PT OT GA <br /> OR ❑ <br /> NR <br /> OTHER LB OZ PT OT GA <br /> OR ❑ <br /> NR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> DA A - <br /> OR <br /> OTHER❑ LB OZ PT OT GA <br /> OR 13 M <br /> MER MR 8❑ LS OZ PT OT OA <br /> MR 8 <br /> NR DF ' <br /> OTM Q LB OZ PT OT GA A,^� 'V <br /> TH LB OZ PT OT GA <br /> REPORT PREPAR B ✓ DATE O O/ REVIEWED BY <br /> n., lirRlnr RnIrlPnmrl..Annlirnlnr FOR AGENCY USE ONLY <br />