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PESTICIDE SPRAY DIARYMeets Recording Requirements for Pesticide Applications under the following

- Ag Vet Control of use Regulations NT

Prepared by:Department of Primary Industry and Fisheries

Chemical Services SectionVersion 5

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Agricultural Chemical Spray Record[Suitable for frequent application to the same areas – such as owners and employees of farming

operations]Name & Address of person for whom the spraying was carried out [land owner or lessee: ................................................................................................................................................

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Operators Details

Operator 1 - Name:..............................................................................................................

Address:..........................................................................................................

Spray Applicator Licence No. (If applicable) :........................................................................

Authorisation for S7 or Restricted Product (if applicable):......................................................

Operator 2 - Name:.............................................................................................................

Address:..........................................................................................................

Spray Applicator Licence No. (If applicable) :........................................................................

Authorisation for S7 or Restricted Product (if applicable) ......................................................

Operator 3 - Name:.............................................................................................................

Address:..........................................................................................................

Spray Applicator Licence No. (If applicable) :........................................................................

Authorisation for S7 or Restricted Product (if applicable) ......................................................

Operator 4 - Name:............................................................................................................

Address:..........................................................................................................

Spray Applicator Licence No. (If applicable) : .......................................................................

Authorisation for S7 or Restricted Product (if applicable) ......................................................

Certification by OperatorI hereby certify that this spray diary contains a true and accurate record of my agricultural spraying activities on the properties described in this diary.Signed : Operator1: ..............................................................Date:............/......../............

Signed : Operator 2: ..............................................................Date:............/......../............

Signed : Operator 3: ..............................................................Date............./......../............

Signed : Operator 4: ..............................................................Date ............/......../............

The information in this diary must be retained for 2 years after the date of spray application as prescribed in the Agricultural and Veterinary Control of Use Regulations, 2004, regulation 9.

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Property Map and Location – Property 1Address of property........................................................................................................................................................................................

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Property Map and Location – Property 2Address of property:.......................................................................................................................................................................................

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RECORDS OF PESTICIDE APPLICATIONS CARRIED OUT

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Grower: ……………………. Farm Location:…………………………………………………

Date Time Time Location Chemical Rate Method Crop Pest & Notes Wind OperatorStart Finish [ref.map] Sign

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Grower: ……………………. Farm Location:…………………………………………………

Date Time Time Location Chemical Rate Method Crop Pest & Notes Wind OperatorStart Finish [ref.map] Sign

EXAMPLES OF HOW TO FILL OUT THIS DIARY

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Extract from Agricultural &Veterinary Chemicals Control of Use Regulations 2004

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