pesticide use reporting forms
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Pesticide Use Reporting FormsPesticide Use Reporting Forms
Mark ConoverSenior Ag & Standards InspectorMariposa County Department of
Agriculture
ABC-123 Inc.
ABC-123 Inc. 456 Smith Street
ABC-123 Inc. 456 Smith Street Mariposa
ABC-123 Inc. 456 Smith Street Mariposa 95338
ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567
ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567PRO123
ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567PRO123
Operator ID or Permit Number Required Here If
One Has Been Issued.
ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567MariposaPRO123
ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567Mariposa 22PRO123
ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567Mariposa 22 Jan. 2012PRO123
ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567Mariposa 22 Jan. 2012PRO123
BASF Phantom
•Where in the world will I find the EPA
Registration number???????
Right here
ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567Mariposa 22 Jan. 2012PRO123
BASF Phantom 241-392-AA
ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567Mariposa 22 Jan. 2012PRO123
BASF Phantom 241-392-AA 3
3 ?
Be sure to include the unit of measurement!
3
3 10
You can use either a “code” in box E or fill in box F & G, Commodity &
Acres.
Don’t forget to include the total
number of applications.
3 10
3
3 10
3
April Showers
3 10
3
April Showers
02/05/2012
January
January 2012
January 2012
22-12-00165
January 2012
22-12-00165 John Smith
January 2012
22-12-00165 John Smith 456 Brown Road
January 2012
22-12-00165 John Smith 456 Brown Road Anytown
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres 524-475
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres 524-475
No Alpha Code??
Check your label!
Alpha Codes
“AA” is default; be sure to check your label to
make sure it is not another code; such as
“ZC” “ZA”…
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres 524-475
2 2/3
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres 524-475
2 2/3
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres 524-475
2 2/3Until Dry
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres 524-475
2 2/3Until Dry
2
qts/acre
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres 524-475
2 2/3Until Dry
2
qts/acre2%
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres 524-475
2 2/3Until Dry
2
qts/acre2%
Monsanto
Roundup Pro
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres 524-475
2 2/3Until Dry
2
qts/acre2%
Monsanto
Roundup Pro
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres 524-475
2 2/3Until Dry
2
qts/acre2%
Monsanto
Roundup Pro
May Flowers
January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland NE Corner of Hwy. 140 & 49N Mariposa, CA 95338
1/18/12
16:00
2 acres 524-475
2 2/3Until Dry
2
qts/acre2%
Monsanto
Roundup Pro
May Flowers
2/8/12
Using a “restricted material?”
You must submit a Notice Of Intent at least 24 hours prior to
any pesticide application,
Let’s fill one out…
If applying restricted
materials to a nursery
check this box.
22
22 14
22 14 06
Select North or South
22 14 06
22 14 06 17
22 14 06 17
22 14 06 17
22 14 06 17
22 14 06 17 John Smith
22 14 06 17 John Smith
22-12-000165
22 14 06 17 John Smith
22-12-000165 JS-01
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa, CA 95338
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa, CA 95338
John Smith
456 Brown Road
Mariposa, CA 95338
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa, CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa, CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa, CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa, CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
What is a chemical
code?
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-475
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
Days Reentry?
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
Days Reentry?
Where Will Where Will I Find This I Find This InformationInformation
??
On the On the Label…Label…
The Label is The Label is the Law!the Law!
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
Until Dry
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
Until Dry John Smith
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
Until Dry John SmithNone
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
Until Dry John SmithNone
John Smith
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
Until Dry John SmithNone
John Smith
2/21/12
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
Until Dry John SmithNone
John Smith
2/21/12 13:00
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
Until Dry John SmithNone
John Smith
2/21/12 13:00 N/A
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
Until Dry John SmithNone
John Smith
2/21/12 13:00 N/A
Hwy 49 North
Hw
y 140
22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa CA 95338
John Smith
456 Brown Road
Mariposa, CA 953382/23/12 – 08:00
2 acres Rangeland
Monsanto Roundup Pro 524-4754 qts
per acre 1.5%Poison
Oak
Until Dry John SmithNone
John Smith
2/21/12 13:00 N/A
Hwy 49 North
Hw
y 140
Agricultural Agricultural Commissioner’s Commissioner’s Office will either Office will either approve or deny approve or deny and fill in these and fill in these
blanks.blanks.
Questions?Questions?
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