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DEPARTSTATE MENT <br /> PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PR-ENF-Cllr'(REV.2'NB) <br /> Instructions: Submit the wtdLQ((_�cooy to the Agricultural Commissioner within ig days of n7unth following application. <br /> mt), ^CG� ZVO,'1 <br /> MONTH , YEAR 2 <br /> u NURSERY ] <br /> _ Page.i of <br /> OPEMTOR ID/PERMIT NUMBEFl OPERATOR(GROWER) EADDRETS CITY ZIP CODE <br />,39 oy 39 Dy929 5 nIB�:; A211 L S+.SITE IDENTIFICATION NUMBER TAT PLANTED ACREAGE/UNITS SECTION TOWNSHIP RANGE BASE A MERIDIAN <br /> 6 '1..- 1 ,D130 12 1$ 10 0 S 1A 10 ®16 5 H <br /> COMMODIT4SITE TREATED FIELD LOCATION <br /> 17 C e <br /> CHEMICAL OA ERIME I ACREAGEAINITS API. BLOCK ID EPA OR STAT E REGISTMTION NUMBER TOTAL PRODUCT U SEO DAYS MTE DILUTION PRODUCT AND MANUFACTURER <br /> CODE NUMBER APPLICATION I TREATED METHOD IF )FROM LABEL) ICIACLE ONE UNIT REENTRY PERACRE <br /> COMPLETED (CHECK APPLICABLE) OF MEASURE) <br /> 21 123 'ONE) 25 26 27 ZB 28 ]O <br /> 31 <br /> A-1 `1 S OR <br /> AR <br /> SZ�1 -ri L 130 �I g /o <br /> 31iblDOTHER❑ TO 02 A OT GA 6, _Or <br /> 311 l�'y <br /> 100 OTHEA� ST4 29 - 3 R A o��G OT GA h�1 10 16, <br /> - <br /> OR ❑ <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 /> OCHER LB OZ PT OT GA <br /> OR RAIR <br /> OTHER ❑ LS OZ PT OT GA <br /> >A ❑ _ pp <br /> AIR 11B \ <br /> OTHER❑ <br /> B OZ PT OT GA <br /> OR <br /> MR n _ <br /> NR <br /> OTHER LB OZ PT OT GA <br /> OR EJf12f+ <br /> dN>�—APR- <br /> MR <br /> An_ Ufl llA <br /> [t)U2 <br /> NR ❑ <br /> OTHER LB OZ PT OT GA <br /> MR ❑ 1 l E+ etl /.Y1OMER❑ PT T--WnlM,.MI-WUNTv <br /> /R FtIL.EA EYL � 'LVDI <br /> ❑ _ <br /> AIR H <br /> OTHER❑ TO OZ PT OT GA <br /> OR <br /> MR ❑ <br /> OTHER❑ LB 'JZ PT or GA <br /> OR B -- <br /> AIR <br /> CTHEA❑ LB OZ PT OT GA <br /> OR ❑ <br /> AR ❑ <br /> OTHER❑ _� LB OZ PT OT CA <br /> REPORT PREPARED BY i"'-- I!N"� DATE_ "I sf^-"r'1REVIEWED BY <br /> Forno Distribution' White copy--County Agricultural Commis-ioner; Pink copy--DPR; Canary--Applicator; Goldenrod--Applicator FOR AGENCY USE ONLY <br />