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I 1 1 I I 1 1 1 1 1 1 1 I I 1 I I 1 I <br /> DSTATE EPARTMENT <br /> PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PR-ENF-017C(REV.2/90) <br /> Instructions: Submit the white cop v to the Agricultural Commissioner within 10 days of month following application. <br /> 02 an <br /> a� ti <br /> MONTH 1 YEAR 2 <br /> l= NURSERY 3 _ <br /> Page __ OI_. . <br /> OPERATOR 10/PERMIT NUMBER OPERATOR(GROWER) ADDRESS CITY ZIP CODE <br />. 39- ov 5 a M B I L 7 TRA0 B 35� <br /> SITE IDENTIFICATION NUMBER TOTAL LANTED ACREAGE/UNITS UN NyUMBER SECTION 3 TOWNSHIPE !� BASEBMFRIDIAN <br /> / Q 11 3J 12 /a 13 QCOO W 15 S_Q1 _.N <br /> COMMODI /SITE TREATED FIELD LOCATION <br /> n r _S 1e CL 1 %2 , <br /> CHEMICAL DATEMIAE ACREAOEAINITS APP. MOCK ID EPA OR STAT E REGISTRATION NUMBER TOTALPRODUCTUSEO DAYS RATE DILUTION PRODUCT AND MANU FACTURER <br /> WOE NUMBER APPLICATION TREATED METHOD (IF (FROM LABEL) (GRCLE ONE UNIT REENTRY PER ACRE <br /> COMPLETED (CHECK APPUQUIU) OF MEASURE) ■\ <br /> 21 22 23 24 ONE) 25 26 27 28 20 30 31 <br /> tillON <br /> 13u OMR 554zt-3RA 19SU �y11" — <br /> 3:at) ` B OZ PT OT GA Is S"1IIv/ )CSG <br /> SII L �2 R 024bU <br /> . ,� OTHER❑ 34�oy-Do�2z An-00000 1/ 3U G-F Du ST <br /> B OZ��PT OT GA <br /> 57 <br /> 20/1,3 <br /> 3..Vy7'tY"1 MR 0 <br /> OTHER❑ ,;'$-y2y- 3V1A LB OZ r FIT OT GA 11 I S S.L�TY)/ 1 GSL <br /> 5120 130 un 91-U / <br /> OTHER e B OZ PT OT GA <br /> / <br /> ONAIR <br /> /^1 <br /> sl j7 /I OTHER❑ 11 <br /> 09 OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LS OZ PT OT GA <br /> -- OR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> ONAIR <br /> ❑ <br /> OT ❑ <br /> OTHER ❑ LB 02 PT DT GA \` <br /> GR ❑ <br /> AIR <br /> OTHER <br /> LB OZ PT OT GA <br /> OR11 <br /> OTHER❑ LB OZ PT OT GA <br /> OR aMR . <br /> OTHER❑ LB OZ PT OT GA d rF I,,,,, <br /> OR <br /> AIR a <br /> OTHER[❑0 <br /> 7 LB OZ PT OT GA <br /> OR <br /> OTHER❑ LB OZ PT OT GAI SA14 10414""F"'U'!T <br /> GR ❑ e <br /> Alp ❑ <br /> OTHER❑ LB OZ PT GT GA <br /> REPORT PREPARED B DATE_ '�/ <br /> „ REVIEWED BY <br /> Form Distribution: White copy--County Agricultural Commissioner: Pink copy--DPH: Canary--Applicator; Goldenrod--Applicator FOR AGENCY USE ONLY <br />