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I I I i i i I I i i 1 I I i I I I i i .STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATION PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT PR-ENF-017G(REV,2/99) Instr coons: Submit the white cony to the Agricultural Commissioner within 10 days of month following application. MONTH 1 YEAR 2 NURSERY 3 Paw�of OPERATOR i0lPERMIT NUMBER OPERATOR{GROWER) �,/^I ��/�({ AD(/D�R9ESJSf CITY ZIP CODE 4 /(XL) l.Z lam►'`4Q�4/, ��Z SITE DEN IFEG TIONINUMBER TOTAL PLANTED ACREAGEIUNI75 COUNTY kUMBER SECTION TOWNSHIP RANGE �^/7 BASE a MERIDIAN 9 /!+ 110 Q 11 112 13 14 O / 16 9 N H COMMODITY/SITE TREATED /� FIELD LOCATION17 C_ 10 �ujazz^4 6L"d6-1,\dqe CHEMICAL E17 ME ACREAGE/UNRTS APA. BLOCK IO EPA OR STATE REGISTRATION NUMBER TOTAL PRODUCT USED DAYS RATE DuJ N PRODUCT AND MA%UFACTUAEkj CODE NUMBER APPLICATION TREATED METHOD (IF (FROM LABEL) (CIRCLE ONE UNIT REENTRY nA ACRE COMPLETED (CHECK APPl1GASLE) OF MEASURE) 21 23 24 ONE) 25 26 27 26 20 30 31 \�r q 1SU IT V �J ip TME" t�CJ r T QT GA I�C&AIIO 2z -h> �J+~ �C1.�+ � OR ❑ AIA ❑ OTHER❑ LB OZ PT OT GA GR ❑ AIR ❑ OTHER ❑ LB OZ PT OT GA GR ❑ NR OTHER LB OZ PT OT GA GR ❑ AIR OTHER B LB OZ PT OT GA OR AIR OTHER{] LB OZ PT OT GA GR ❑ AIR ❑ OTHER❑ LB OZ PT OT GA AIR Ll OTHER❑ LB OZ PT QT GA GR ❑ }1 �^ AIR ►, OTHER LB OZ PT QT GA OR ❑ AIR [] OTHER❑ LB OZ PT OT GA AIR OTHER Le oz PT QT GA OR ] AIR ❑ OTHER❑ LB OZ PT OT GA GR AIR OTHER❑ ,LB OZ PT OT GA Gel ❑ AIR ❑ OTHER❑ L9 OZ PT OT GA REPORT PREPARED BY DATE REVIEWED BY rr7 [ +„ i .u[•,_:� '''' hila cop Ccun A ncu;tural CJmmissionor' Pink co C?R', Cana 4 licator, Goldenrod--A licatnr FOR AGENCY USE ONLY y ty g PY- Canary- PP PP