Download - Pesticide Use Reporting Forms
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Pesticide Use Reporting FormsPesticide Use Reporting Forms
Mark ConoverSenior Ag & Standards InspectorMariposa County Department of
Agriculture
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ABC-123 Inc.
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ABC-123 Inc. 456 Smith Street
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ABC-123 Inc. 456 Smith Street Mariposa
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ABC-123 Inc. 456 Smith Street Mariposa 95338
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ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567
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ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567PRO123
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ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567PRO123
Operator ID or Permit Number Required Here If
One Has Been Issued.
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ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567MariposaPRO123
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ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567Mariposa 22PRO123
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ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567Mariposa 22 Jan. 2012PRO123
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ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567Mariposa 22 Jan. 2012PRO123
BASF Phantom
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•Where in the world will I find the EPA
Registration number???????
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Right here
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ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567Mariposa 22 Jan. 2012PRO123
BASF Phantom 241-392-AA
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ABC-123 Inc. 456 Smith Street Mariposa 95338 209-123-4567Mariposa 22 Jan. 2012PRO123
BASF Phantom 241-392-AA 3
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3 ?
Be sure to include the unit of measurement!
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3
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3 10
You can use either a “code” in box E or fill in box F & G, Commodity &
Acres.
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Don’t forget to include the total
number of applications.
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3 10
3
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3 10
3
April Showers
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3 10
3
April Showers
02/05/2012
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January
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January 2012
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January 2012
22-12-00165
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January 2012
22-12-00165 John Smith
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January 2012
22-12-00165 John Smith 456 Brown Road
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
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January 2012
22-12-00165 John Smith 456 Brown Road Anytown 99999JS-01 18 Acres 22 14 06 17
Rangeland
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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
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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
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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
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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
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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
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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!
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Alpha Codes
“AA” is default; be sure to check your label to
make sure it is not another code; such as
“ZC” “ZA”…
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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
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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
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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
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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
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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%
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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
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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
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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
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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
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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…
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If applying restricted
materials to a nursery
check this box.
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22
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22 14
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22 14 06
Select North or South
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22 14 06
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22 14 06 17
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22 14 06 17
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22 14 06 17
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22 14 06 17
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22 14 06 17 John Smith
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22 14 06 17 John Smith
22-12-000165
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22 14 06 17 John Smith
22-12-000165 JS-01
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22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
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22 14 06 17 John Smith
22-12-000165 JS-01 22 acres
NE Corner of Hwy 140 & 49 N., Mariposa, CA 95338
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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
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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
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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
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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
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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?
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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
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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
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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
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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%
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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
![Page 85: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/85.jpg)
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?
![Page 86: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/86.jpg)
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?
![Page 87: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/87.jpg)
Where Will Where Will I Find This I Find This InformationInformation
??
![Page 88: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/88.jpg)
On the On the Label…Label…
The Label is The Label is the Law!the Law!
![Page 89: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/89.jpg)
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
![Page 90: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/90.jpg)
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
![Page 91: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/91.jpg)
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
![Page 92: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/92.jpg)
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
![Page 93: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/93.jpg)
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
![Page 94: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/94.jpg)
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
![Page 95: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/95.jpg)
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
![Page 96: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/96.jpg)
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
![Page 97: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/97.jpg)
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.
![Page 98: Pesticide Use Reporting Forms](https://reader038.vdocument.in/reader038/viewer/2022110102/56813dfe550346895da7d8d3/html5/thumbnails/98.jpg)
Questions?Questions?