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STAT"DH GALUUMNIA PHUUUGT7UN ACiHI(:UL 1 UHt MVN 1 MLT I'tA�I I�iIUC UA C FSCYVFS 1 <br /> D�FARTMENT OF PESTICIDE REGULATION <br /> W-ENF-OI7C(REV.&W) <br /> instructions: Submit the white coov to the Agricultural Commissioner within 10 days of month following application. <br /> J.4n/ " <br /> MONTH 1 YEAR 2 1 <br /> NURSERY 3 Page 1' UI-__J <br /> OPERATOR ID/PERMIT NUMBER OPERATOR(GROWER) ADDRESS �J CITY ZIP CODE <br /> 9o+flo 6 , 03 02-3 <br /> SITE IDENTIFICATION NUMBER TOTAL PLA9NTE�DjAC�REAGE/UNITS COUNTY NUMBER SECTION TOWNSHIP RANGE BASE!MERIDIAN <br /> -119 12 00 ,S 3 S ,A '3 W ,B 5 H _. <br /> COMMODITY/SITE TREATED FIELD LOCATION <br /> B N y/Z y� P <br /> 17 <br /> CHEMICAL OATETME AL TREA EXRf APP. BLOCK EPA OR STATEREGISTRATIONNUMBER TOTALPRODUCTONE UN70 ENT IRATE ORUTgM PRODUCT AND MANUFACTURER <br /> CODE XUMBER APPLILATED TRGTfD METHOD IIF (FROM LABEL) (CIRCLE EASU UNrt REENTRY PER ACRE <br /> COMPLETED (OXECN APPDGBLE) OF MEASURE) <br /> onEl Z7 28 20 30 31 <br /> 21 22 23 21 25 26 �SU <br /> OR <br /> .2s0 OTHER❑ —00;wo—,logLB OZ OT GA <br /> OR <br /> ��Lpl+ <br /> !F !r OT <br /> OTHER [3 3sJ - 003VA— ZA LB OZ3 OT GA .2p1'. <br /> uA <br /> P /8/2 - G�oas7- Z <br /> OTHER C-1LB OZ OTT GA — <br /> /A oTnER❑ ��6 (p - 00 7.5—44 LB PT OT GA ,/ <br /> o I n <br /> OMR <br /> R Q OTNERI 9279-oc,/31- n_ OZ PT OT GA <br /> OR BAIR <br /> OTHER ❑ LB OZ PT OT GA <br /> OR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> NR <br /> OTHER LB OZ PT OT GA <br /> OR ❑ <br /> uR <br /> OTHER LS OZ PT OT GA <br /> OR ❑ <br /> AIR Cl <br /> OTHER❑ LB 02 PT OT GA <br /> DR <br /> MR <br /> OTHER❑ LB OZ PT OT GA <br /> OR 8AIR <br /> OTHER❑ LB OZ PT OT GA <br /> OR BuR <br /> OTHER❑ LB OZ PT OT GA <br /> OR ❑ <br /> NR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> REPORT PREPARED BY — DATE �0 .2 REVIEWED BY <br /> !-:nm FOR AEEcncr u86 ONLY <br /> 171stlihutiorl: While copy— n <br /> G°u ,Y -^glicuIt,n AHI Jaunnir loner, Pln� vpy---I) ', C.1nary—APpli°alpr, GaldanrtHd--Applical°r <br />