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S1H1 C OF w mLIFVr NIA <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT <br /> MONTH 1 YEAR 2 <br /> NURSERY 3 <br /> Page of <br /> OPERATOR ID/PERMIT NO. OP ATOR (GROWER) ADDRESS CITY it� r ZIP CODE <br /> SITE ID NO. TOTAL PLANTED ACREAGE/UNITS COUNTY NO. SECTION / TOWNSHIP RANGE BASE & MERIDIAN <br /> 9 10 11 12 ! 13 .01 15 S M H <br /> COMMODITY/SITE TREATED FIELD LO TION <br /> CHEMICAL DATE/TIME ACRE 1E/UNITS APP. BLOCK ID EPA/CALIF. REG. NO. FROM LABEL TOTAL DAYS RATE DILUTION PRODUCT/MANUFACTURER <br /> NUMBER APPLICATION TREATED METH. IIF PRODUCT USD REENTRY PER ACRE <br /> COMPLETED (CHECK APPLICABLE) <br /> (CIRCLE ONE UNIT <br /> 21 22 23 24 <br /> ONE) 25 26 27 OF MEASURE) 29 29 30 31 <br /> AIR <br /> GR <br /> OTHER❑ [/�- � � � LB Z ITOT GAOGA �LES <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB 02 IT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ IT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ IT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ IT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ IT OT GA ) �j <br /> GR <br /> AIR ❑ "x.k; i`7�a�II f..I-.,I �' �I'�1�1 I'�� !l `I A.�, ,�F`11•, <br /> OTHER E) LB OZ PT OT GA i l 1\I 1"17 ;'y r I ,.�'i �_I � (II'1 I -J <br /> GR ❑ 1' 1_a,• Y_ '' 1.1 � 1 ..�p ,,w <br /> AIR ❑ <br /> OTHER❑ LB OZ IT OT GA �F•` <br /> GR ❑ __. <br /> AIR ❑ <br /> OTHER❑ LB OZ PT OT GA <br /> GR ❑ ,R.tf6'1: • ./r - S <br /> AIR ❑ <br /> OTHER El LB OZ IT OT GA �'i:.'Z jlJ'.. •, �. `•��•' <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ LB OZ IT OT GA <br /> GR ❑ <br /> AIR ❑ <br /> OTHER❑ 01 LB OZ IT OT GA <br /> REPORT PREPARED BY DATE REVIEWED BY <br /> Submit to Agricultural Commissioner within 10 days of month follapplication PFfE -017C ( ev 1/95) For Agency Use Only <br /> (') CAC <br />