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DEPARTMENT OF PESTICIDE REGULATION <br /> 1'MVUU%,I1UN AIItIlt ULI UPSC III1116T rr-QIIMIL/C V.7C IICrVn1 <br /> PR-ENF 017C(REV.2/BB) <br /> Instructions: Submit the white coov to the Agricultural Commissioner within 10 days of month following application. <br /> A/ <br /> MONTH i YEAR 2 <br /> NURSERY 3 Page--1O1 <br /> OPERATOR ID/PERMIT NUMBER OPERATOR(GROWER) ADDRESS / , ,�J,, CITY ZIP CODE <br /> 3 '. 9 O s ��-'7�i��/ S. E 3�.s Gt/• /!JC///Sl�ONG�. 7 Ld / e Y,SirZ�i� <br /> 4 <br /> SITE IDENTIFICATIONNUMBER TOTAL PLAN T'ED A`CREAGE/UNITS COUNTY NUMBER SECTION E� TOWNSHIP RANGE BASE A MERIDIAN <br /> � 02 10 �J 11 / 12 d 13 1{ 15 S M N <br /> COMMOOI TYISIT�EC/TA�R/SEA I�u / FIELD LOCATION17 <br /> CHEMICAL DATE/TIME ACREAOENNR8 APP. BLOCK ID EPA OR STATE REGISTRATION NUMBER TOTAL PRODUCT USED DAYS RATE DILUTION PRODUCT AND MANUFACTURER <br /> CODE NUMBER APPLICATION TREATED METHOD (If (FROM LABEL) (CIRCLE ONE UNR REENTRY PER ACRE <br /> COMPLETED (CHECK APPUCABLE) Of MEASURE) <br /> 21 22 23 24 ONE) 25 26 <br /> 27 28 20 30 31 <br /> A dd 87s <br /> 3:D0 aSD OTHER❑ /aJ j?;Z— LB a PT OT GA Z. �^ <br /> OR ❑ <br /> MR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> MR <br /> OTHER 8 LB OZ PT OT GA <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 /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> AIR <br /> OTHER LB OZ PT OT OA <br /> OR ❑ <br /> AIR <br /> OTHER LB OZ PT OT GA <br /> OR ❑ <br /> NR E-)OTHER 71LB OZ PT OT GA <br /> OR <br /> MR <br /> OTHER❑ LS OZ PT OT GA <br /> OR _ <br /> MR <br /> OTHER❑ LB OZ PT OT GA <br /> OR 8AIR <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> AIR ❑ <br /> OTHER❑ LB 02 PT OT GA <br /> REPORT PREPARED BY DATE /a �( REVIEWED BY <br /> . FOR AGENCY UINE ONLY <br /> . )I=(iGutibu. VVhitb eOpy--CuunP�Ayv�aui+u lal COnunl („Ile 1; Pill(r,.�py- PRI canary--APPIICc- ntl <br />