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SCOTTISH QUALITY CROPS FARM RECORD BOOK Index Page 2 SQC Checklist 3 Crop summary/General information 4 Farm emergency action plan 5-6 Pesticide store & stocklist 7-9 Rodent records & bait point location plan 10-11 Environmental Risk Assessment Form 12 Glass protection system 13 Grain store – Pre-harvest hygiene checks 14-15 Grain stores – weekly/monthly checks 16-17 Sprayer self assessment & basic calibration form 18-19 Sprayer self assessment & calibration for electronic rate controllers 20 Mycotoxins risk assessment for wheat 21 Annual checks - Machinery 22-39 Field records 40-41 Grain Movement Record 42 Complaints register Scottish Quality Crops Acoura, 6 Redheughs Rigg Edinburgh, EH12 9DQ Tel: 0131 335 6604 Fax: 0131 335 6601 www.sqcrops.co.uk Growing Season _________

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SCOTTISH QUALITY CROPSFARM RECORD BOOK

Index

Page2 SQC Checklist3 Crop summary/General information4 Farm emergency action plan5-6 Pesticide store & stocklist7-9 Rodent records & bait point location plan10-11 Environmental Risk Assessment Form12 Glass protection system13 Grain store – Pre-harvest hygiene checks14-15 Grain stores – weekly/monthly checks16-17 Sprayer self assessment & basic calibration form18-19 Sprayer self assessment & calibration for electronic rate controllers20 Mycotoxins risk assessment for wheat21 Annual checks - Machinery22-39 Field records40-41 Grain Movement Record42 Complaints register

Scottish Quality CropsAcoura, 6 Redheughs Rigg

Edinburgh, EH12 9DQTel: 0131 335 6604 Fax: 0131 335 6601

www.sqcrops.co.uk

Growing Season ___ ______

SCOTTISH QUALITY CROPS CHECKLIST

1 Do you have access to the relevant codes of practice either on paper or via the relevant website?

2 Can you provide cropping figures on current and previous years?

3 Field records to include - • Fertiliser application including FYM, slurry.• Spray records including LERAPS and slug pellet application.• Sowing dates including seed treatment and Harvest dates.• Spray records to be fully completed, signed & dated.

4 Compost, biosolids, digestate - • Origin, delivery note and application record, PAS 100/110 certificate• SEPA Exemption where necessary.

5 Fertiliser spreader date of last service/calibration.

6 Chemical store locked, bunded, sign, no out of date chemicals.

7 Waste disposal, recycling waste transfer ticket.

8 Spray operator’s certificate of competence PA1 PA2A (PA4s for slugs)• NRoSO number end expiry date or certificate of attendance at SOC course.• Booking Reference & Date for SOC course if not the operator has

not yet attended for the current scheme year. • Sprayer Contractors Certificate of Competence PA1/2/4S .

9 Sprayer MOT date and number or completed self-assessment form. A copy of a written calibration must be available.

10 BASIS advisor on BASIS Professional Register or copy of BASIS Advisors current card.

11 Record any fields with ergot (CCP).

12 Completed mycotoxin risk assessment (CCP).

13 Rodent records poison used, dates checked, plan of bait stations & CRRU Environmental Risk Assessment completed.

• If contractor used, the Certificate of Competence for the individual technician should be available.

14 Grain store record dates of cleaning including method, disinfectant or insecticide used• Record dates for glass checked including spotlights, skylights and any machinery entering store.

15 Record dates for checks on crop handling including combine, forklift, drier.

16 Moisture meter record date calibrated/checked.

17 Long term store, record temperature of grain.

18 Grain trailer record date of cleaning and disinfectant if used.

19 Grain movements, record dates of grain leaving farm.

20 Record any complaints.

21 Farm Emergency Plan available and visible.

GENERAL INFORMATION

SEERAD FARM CODE (CPH):

Crop Summary

Crop Ha Crop HaSpring Barley Vegetables Winter Barley Pulses Winter Wheat Fruit Spring Wheat Temporary grass Spring OSR Permanent grass Winter OSR Other Spring Oats Total Ha Winter Oats

Contractors/Rodent Contractor/Chemical Suppliers

Name/Company Telephone Number Address

Consultants FACTS/BASIS Details

Name and Company Registration Number

Basis Adviser

Facts Adviser

Spray Operator Details

Name/Company Certificate of Competence No

SOC Course

Date Attended NRoSO No Expiry Date

Waste Exemption Numbers

Local Beekeepers/Beekeeper Liaison Officer

Name Telephone

FARM EMERGENCY ACTION PLANIn case of emergency dial 999 from your mobile phone or the nearest landline which is situated:

Give the following information including the nature of incident including any remaining hazards:

Farm Name and Address:

OS Ref:

Farm contact:

Farm telephone No:

Location of Domestic Water SupplyField Name, OS No. etc:

Move any staff, livestock and machinery away from the danger area if safe to do so.

LOCATION OF IMPORTANT FACILITIESLocation of fire extinguishers:

Location of gas and electricity isolation points:

Location of washing facilities:

Location of nearest water source (tap, bowser or other water source etc):

Location of surface water and foul water drains:

Location(s) of first aid box: Trained First Aider:

Other Useful Contacts Telephone NumbersLocal Casualty Department Local SEPA /Environmental Agency Tel No Doctors Tel No and Name Local Police Station Local Fire Dept Electricity Company Gas Company Water Company Emergency Waste Disposal Company

DON’T TAKE RISKS – Remember to display a copy for your staff!

DATE PESTICIDE AMOUNT IN (ltrs)

AMOUNT OUT(ltrs)

TOTALIN STOCK

(ltrs)SIGNATURE COMMENTS

Chemical store (annual check to identify if store contains pesticides for which approval has been withdrawn or will be withdrawn within the next two years)

Date of check Checked by Action / Result

PESTICIDE STORE AND STOCK LIST

DATE PESTICIDE AMOUNT IN (ltrs)

AMOUNT OUT(ltrs)

TOTALIN STOCK

(ltrs)SIGNATURE COMMENTS

Chemical store (annual check to identify if store contains pesticides for which approval has been withdrawn or will be withdrawn within the next two years)

Date of check Checked by Action / Result

PESTICIDE STORE AND STOCK LIST

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Plan

ENVIRONMENTAL RISK ASSESSMENT FORM READ THE ADVISORY NOTES PROVIDED BEFORE YOU CARRY OUT AN ASSESSEMENT

Before the ERA Name of Site and Address:

Name of Client and/or Client's site representa�ve:

Contract no:

Name of Assessor:

Date of Assessment:

The Infesta�on Carry out a site survey and provide the document reference. Document ref: …………………………………… Were environmental risks noted during the survey? Complete an ERA and the remainder of this form is the answer is yes. Yes / No Is there a current rodent infesta�on?

Rat: Yes / No Mouse: Yes / No Is the rodent infesta�on situated only indoors and will baits only be placed indoors? Yes / No Is there a significant risk to human health or animal health presented by a possible future infesta�on?

Yes / No Do you intend to use long-term bai�ng?

Yes / No If ‘yes’ give the reference to the document showing jus�fica�on: Document ref: ……………………………………

Risk Hierarchy Why is it necessary to use a roden�cide at this site? Why can’t the situa�on be resolved by other methods, such as improving hygiene and preven�ng rodent ingress to sensi�ve areas or traps?

If you intend to use SGARs and not FGARs explain why.

CRRU Stewardship

Sensitive areas Record if the site is entirely, or contains a part of, one of the designated sensitive areas listed in the advisory leaflet. If so, list any protected species that may be present.

Products Give product name, active ingredient and HSE Authorisation Numbers† for all products to be used.

The ERA* Provide a list of all environmental risks you perceive to be present at the site:

Provide a list of all the measures you will use during rodenticide application at the site to reduce the risks you have identified:

Disposal of rodent carcases

How often will you search for rodent carcases?

Will others on site also seach for rodent carcases? Yes / No What measures will you use safely to dispose of rodent carcases?

Disposal of spent bait

How will you dispose of spent bait?

Conclusion With due consideration to the information recorded above, can this treatment safely proceed without unacceptable damage to wildlife and the environment?

Yes / No

* if there is insufficient room in the boxes provided use additional sheets and secure them to this sheet. † shown on product labels

The Campaign for Responsible Rodenticide Use (CRRU) UK

The CRRU UK Rodenticide Technician’s Signature Client’s Signature Stewardship Regime

OCTOBER 2016

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SQC Sprayer Maintenance and Self Assessment form (complete annually if sprayer not NSTS tested)

Owner: Operator: Make:Model: PA Cert no: Reg No:Date: NRoSO no:

Regularly

Mechanical

Is the attachment to tractor secure?

Is the chassis and structure free of cracks and rust?

Are the wheels and tyres in good condition?

Are guards, inc. PTO shaft guard, secure and undamaged?

Hydraulic system, inc. tracking system if fitted.

Are they free from leaks under pressure?

Are the hoses and connections worn or cracked?

Electrical system

Is the wiring undamaged & are all connections properly insulated?

Do all the lights work properly?

Pneumatic system

Is the system free from leaks when under working under operating pressures?

Sprayer tank

Are the tank/chassis fasteners secure?

Free from leaks?

Does the lid fit securely and free from leaks?

Is the contents gauge clearly legible?

Boom

Is it properly latched when folded for transport?

When unfolded, is it straight and level?

Does the height adjustment and suspension work properly?

Does the boom return to level when displaced to left and right?

Are the break-backs functioning freely?

Are the mountings and linkages secure and not worn?

'Spray lines'

Are they free from leaks under pressure?

No hoses and connectors worn or cracked?

Are all valves and filters in good condition?

Nozzles

Are all fittings and turrets in good condition?

Are all nozzles correctly orientated?

Are all check valves working properly?

Is the spray/distribution pattern visually correct?

Regularly (cont)

Controls and valves

Are the master on/off switches working correctly?

Are all boom section switches functioning?

Can you read the pressure gauges easily?

Are all labels appropriate and legible?

Is the pressure adjustment/stable?

Pressure gauge reading zero?

Chemical induction system

Are the system and controls working properly?

Is it free from leaks under pressure?

Are all labels appropriate and readable?

Is the rinse system and container wash system working properly?

Tank rinse system

Is the system functioning properly?

External washdown

Is the system functioning properly?

Personal

Water supply tank filled?

Is the clothing locker clean and contents complete?

Periodical

Jug test all nozzle outputs

Date Completed ………………………….

Formally complete and file check sheet

Independent test due (if applicable)……………………

Maintenance Required/Completed/Specific items requiring attention

Key: Checked/Completed Needs Attention X

Adjusted A Not Applicable na

Calibration Record

CalibrationMust be carried out regularly at the beginning of each spray season, (spring and autumn), and regularly during the season and always after changing tractor, tractor wheels, nozzles or replacing any part of the spray delivery system.

When calibrating the sprayer, wear a minimum of a coverall, gloves and boots:

Enter Values

Read the LABEL Spray VOLUMESpray DOSESpray QUALITY

Measure TIME per 100m Measure time in seconds over land similar to that to be sprayed

Calculate SPEED Speed = 360 ÷ Time (seconds)

Measure nozzle SPACING on boom

(normally 0.5m)

Calculate nozzle OUTPUT Output = Volume x speed x space ÷ 600 (Litres/min) (litres/ha) (km/h) (metre)

Select NOZZLE Refer to nozzle manufacturers chart and select size and type of nozzle that will produce the calculated OUTPUT and required spray QUALITY

Now check the calibration of the sprayer:

Check Nozzle OUTPUT Using water, check output of 4 or more nozzles using a calibration jug or flow meter.

Calibrate SPRAYER Volume = output x 600 ÷ space ÷ speed(Litres/ha) (litres/min) (metre) (km/h)

Record Details Date Completed: ______________

Nozzles fitted Tractor usedSpray volume Tractor gearSpray pressure Tractor wheelsSpray quality Tractor revsForward speed

Further forms can be downloaded from the SQC Website www.sqcrops.co.uk or obtained by telephoning the Acoura office: 0131 335 6604

This form is reproduced with kind permission of the BCPC

SQC Sprayer Maintenance and Self Assessment form (complete annually if sprayer not NSTS tested)

Owner: Operator: Make:Model: PA Cert no: Reg No:Date: NRoSO no:

Regularly

Mechanical

Is the attachment to tractor secure?

Is the chassis and structure free of cracks and rust?

Are the wheels and tyres in good condition?

Are guards, inc. PTO shaft guard, secure and undamaged?

Hydraulic system, inc. tracking system if fitted.

Are they free from leaks under pressure?

Are the hoses and connections worn or cracked?

Electrical system

Is the wiring undamaged & are all connections properly insulated?

Do all the lights work properly?

Pneumatic system

Is the system free from leaks when under working under operating pressures?

Sprayer tank

Are the tank/chassis fasteners secure?

Free from leaks?

Does the lid fit securely and free from leaks?

Is the contents gauge clearly legible?

Boom

Is it properly latched when folded for transport?

When unfolded, is it straight and level?

Does the height adjustment and suspension work properly?

Does the boom return to level when displaced to left and right?

Are the break-backs functioning freely?

Are the mountings and linkages secure and not worn?

'Spray lines'

Are they free from leaks under pressure?

No hoses and connectors worn or cracked?

Are all valves and filters in good condition?

Nozzles

Are all fittings and turrets in good condition?

Are all nozzles correctly orientated?

Are all check valves working properly?

Is the spray/distribution pattern visually correct?

Regularly (cont)

Controls and valves

Are the master on/off switches working correctly?

Are all boom section switches functioning?

Can you read the pressure gauges easily?

Are all labels appropriate and legible?

Is the pressure adjustment/stable?

Pressure gauge reading zero?

Chemical induction system

Are the system and controls working properly?

Is it free from leaks under pressure?

Are all labels appropriate and readable?

Is the rinse system and container wash system working properly?

Tank rinse system

Is the system functioning properly?

External washdown

Is the system functioning properly?

Personal

Water supply tank filled?

Is the clothing locker clean and contents complete?

Periodical

Jug test all nozzle outputs

Date Completed ………………………….

Formally complete and file check sheet

Independent test due (if applicable)……………………

Maintenance Required/Completed/Specific items requiring attention

Key: Checked/Completed Needs Attention X

Adjusted A Not Applicable na

Calibration Record – sprayers fitted with electronic controllers –for pressure and flow based control systems

Must be carried out regularly at the beginning of each spray season, (spring and autumn), and regularly during the season and always after changing tractor, tractor wheels, nozzles or replacing any part of the spray delivery system.

When calibrating the sprayer, wear a minimum of a coverall, gloves and boots:Make sure the sprayer is clean and flushed outside and inside to reduce the chance of contamination. Clean all filters.

Step Action Completion record/values

1 Half fill sprayer tank with water and take to a suitable field.Run sprayer to measure travelling speed from the sprayer based system. Check the results are accurate by using the formula: Speed = 360 ÷ time in seconds to travel 100m.Or cross reference from GPS system.(The tractor speed system cannot be relied on for accuracy)

2 Check the rate controller system is functioning in the manual setting and that the pressure can be increased and decreased.

3 Set the pressure to a suitable pressure for the nozzle used.(suggested pressure is 3.0bar except for low pressure nozzles)Visually check nozzles.If spray pattern looks wrong or the nozzle drips, clean the jet & if this does not help replace the jet or nozzle.

4 Set sprayer box in automatic and put in a simulated speed setting so that the sprayer will spray while stationary.Set the controller to an appropriate rate for the size of the nozzles. (the ltrs/ha and speed you would actually use)Check the output of at least 4 nozzles using a calibration jug or flowmeter.

5 With the recorded nozzle output apply the flow/application rate formulae to confirm Rate Controller is performing correctly:

Output = Volume x Speed x Spacing ÷ 600ltrs/min ltrs/ha km/hr meter

For pressure based systems:Calibrate all nozzle sets in “manual mode” as in the third box from the top.

Date completed: __________________

Using flow based systems, if the nozzle is worn, liquid application will be correct but the drop size and pattern will vary. If using a pressure based system and the nozzle is worn, droplet size should be acceptable but application rate will be higher.

The usable capacity of the tank can be checked once the rate controller and nozzles have been calibrated. Fill the tank full with water and zero the “volume used” display. Spray out the contents until empty. Volume displayed will be the usable capacity of the tank. There will nearly always be some liquid left in the pipes, pump and a small amount will be left in the tank.

Further forms can be downloaded from the SQC Website www.sqcrops.co.uk or obtained by telephoning the Acoura office: 0131 335 6604.

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hine

Dat

e of

che

ckC

heck

ed b

yM

aint

enan

ce a

nd

Uni

form

ity o

f di

strib

utio

nC

alib

ratio

n ch

eck

Actio

n / R

esul

t

Spra

yer(

carry

out a

t the

beg

inni

ng o

f spr

ing

and

autu

mn

seas

ons,

and

regu

larly

thro

ugho

ut th

e se

ason

s or

afte

r cha

ngin

g no

zzle

s or

oth

er p

arts

of t

he d

eliv

ery

syst

em).

Mac

hine

Dat

e of

che

ckO

r NST

S te

st

date

Che

cked

by

Mai

nten

ance

che

ckor

N

STS

Test

Num

ber

Cal

ibra

tion

chec

kAc

tion

/ Res

ult

Gra

in d

rier/C

ombi

ne/L

oadi

ng E

quip

men

t Mai

nten

ance

Che

cks

Mac

hine

Dat

e C

heck

edC

heck

ed b

yM

aint

enan

ce R

equi

red

Actio

n/R

esul

t

Moi

stur

e m

eter

(cal

ibra

ted

agai

nst s

tand

ards

)Tr

aile

r/Loa

der p

re-h

arve

st h

ygie

ne

Dat

e of

che

ckC

heck

ed b

yAc

tion

/ Res

ult

Dat

e C

lean

ing

Proc

ess

(sw

ept/p

ower

was

hed)

Dis

infe

ctan

t Use

d

Har

vest

Yea

r ....

......

......

.FI

ELD

REC

OR

DFi

eld

Nam

e/N

o:Ar

ea:

Cro

p:

Ergo

t:*

Pres

ent

/

N

ot P

rese

nt*D

elet

e as

app

ropr

iate

Har

vest

Dat

e:Fe

rtilis

er (i

nclu

ding

FYM

/slu

rry):

Hom

e Sa

ved

Seed

Ye

s / N

oPu

rcha

sed

Seed

Lot

Num

ber:

Varie

ty:

Seed

Trea

tmen

t:D

ate:

Rat

e:N

:P:K

Accu

mul

ativ

e N

itrog

en

Appl

ied

Soil

Type

:

Prev

ious

Cro

p:So

win

g D

ate:

Se

ed R

ate:

Cul

tivat

ions

:So

ilAn

alys

is:

pHP

KM

g

Dat

e:

*Com

post

/Dig

esta

te *

Del

ete

as a

ppro

pria

teO

rigin

and

Bat

ch

No:

Del

iver

y D

ate:

PAS:

Perm

it:Ap

plic

atio

n D

ate:

Appl

icat

ion

Rat

e:

N:P

:KAc

cum

ulat

ive

Nitr

ogen

Ap

plie

dSu

pplie

r:Su

pplie

r:

Oth

er A

pplic

atio

nsD

ate

appl

ied

Cro

p G

SR

easo

n fo

r tre

atm

ent

List

all

prod

ucts

ap

plie

dD

ose

Rat

eW

ater

Vo

lum

eSp

ray

Qua

lity

Win

d D

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ion

Win

d Sp

eed

Ope

rato

rSp

ray

time

star

t

fini

shC

ost

LER

AP( P

leas

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k)

Pest

icid

e C

lass

ifica

tion

% D

ose

Rat

eSp

raye

r R

atin

gSi

ze o

f Wat

er C

ours

eSi

ze o

f Buf

fer Z

one

Dat

e of

Le

rap

Sign

atur

e

12

34

1m2m

3m4m

5m>

5m

1 =

Dry

Ditc

h

2 =

<3

m

3 =

3 -6

m

4 =

>6m

Dat

eap

plie

dC

rop

GS

Rea

son

for t

reat

men

tLi

st a

ll pr

oduc

ts

appl

ied

Dos

e R

ate

Wat

er

Volu

me

Spra

y Q

ualit

yW

ind

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ctio

nW

ind

Spee

dO

pera

tor

Spra

y tim

est

art

fi

nish

Cos

t

Har

vest

Yea

r ....

......

......

.FI

ELD

REC

OR

DFi

eld

Nam

e/N

o:Ar

ea:

Cro

p:

Ergo

t:*

Pres

ent

/

N

ot P

rese

nt*D

elet

e as

app

ropr

iate

Har

vest

Dat

e:Fe

rtilis

er (i

nclu

ding

FYM

/slu

rry):

Hom

e Sa

ved

Seed

Ye

s / N

oPu

rcha

sed

Seed

Lot

Num

ber:

Varie

ty:

Seed

Trea

tmen

t:D

ate:

Rat

e:N

:P:K

Accu

mul

ativ

e N

itrog

en

Appl

ied

Soil

Type

:

Prev

ious

Cro

p:So

win

g D

ate:

Se

ed R

ate:

Cul

tivat

ions

:So

ilAn

alys

is:

pHP

KM

g

Dat

e:

*Com

post

/Dig

esta

te *

Del

ete

as a

ppro

pria

teO

rigin

and

Bat

ch

No:

Del

iver

y D

ate:

PAS:

Perm

it:Ap

plic

atio

n D

ate:

Appl

icat

ion

Rat

e:

N:P

:KAc

cum

ulat

ive

Nitr

ogen

Ap

plie

dSu

pplie

r:Su

pplie

r:

Oth

er A

pplic

atio

nsD

ate

appl

ied

Cro

p G

SR

easo

n fo

r tre

atm

ent

List

all

prod

ucts

ap

plie

dD

ose

Rat

eW

ater

Vo

lum

eSp

ray

Qua

lity

Win

d D

irect

ion

Win

d Sp

eed

Ope

rato

rSp

ray

time

star

t

fini

shC

ost

LER

AP( P

leas

e tic

k)

Pest

icid

e C

lass

ifica

tion

% D

ose

Rat

eSp

raye

r R

atin

gSi

ze o

f Wat

er C

ours

eSi

ze o

f Buf

fer Z

one

Dat

e of

Le

rap

Sign

atur

e

12

34

1m2m

3m4m

5m>

5m

1 =

Dry

Ditc

h

2 =

<3

m

3 =

3 -6

m

4 =

>6m

Dat

eap

plie

dC

rop

GS

Rea

son

for t

reat

men

tLi

st a

ll pr

oduc

ts

appl

ied

Dos

e R

ate

Wat

er

Volu

me

Spra

y Q

ualit

yW

ind

Dire

ctio

nW

ind

Spee

dO

pera

tor

Spra

y tim

est

art

fi

nish

Cos

t

Har

vest

Yea

r ....

......

......

.FI

ELD

REC

OR

DFi

eld

Nam

e/N

o:Ar

ea:

Cro

p:

Ergo

t:*

Pres

ent

/

N

ot P

rese

nt*D

elet

e as

app

ropr

iate

Har

vest

Dat

e:Fe

rtilis

er (i

nclu

ding

FYM

/slu

rry):

Hom

e Sa

ved

Seed

Ye

s / N

oPu

rcha

sed

Seed

Lot

Num

ber:

Varie

ty:

Seed

Trea

tmen

t:D

ate:

Rat

e:N

:P:K

Accu

mul

ativ

e N

itrog

en

Appl

ied

Soil

Type

:

Prev

ious

Cro

p:So

win

g D

ate:

Se

ed R

ate:

Cul

tivat

ions

:So

ilAn

alys

is:

pHP

KM

g

Dat

e:

*Com

post

/Dig

esta

te *

Del

ete

as a

ppro

pria

teO

rigin

and

Bat

ch

No:

Del

iver

y D

ate:

PAS:

Perm

it:Ap

plic

atio

n D

ate:

Appl

icat

ion

Rat

e:

N:P

:KAc

cum

ulat

ive

Nitr

ogen

Ap

plie

dSu

pplie

r:Su

pplie

r:

Oth

er A

pplic

atio

nsD

ate

appl

ied

Cro

p G

SR

easo

n fo

r tre

atm

ent

List

all

prod

ucts

ap

plie

dD

ose

Rat

eW

ater

Vo

lum

eSp

ray

Qua

lity

Win

d D

irect

ion

Win

d Sp

eed

Ope

rato

rSp

ray

time

star

t

fini

shC

ost

Har

vest

Yea

r ....

......

......

.FI

ELD

REC

OR

DFi

eld

Nam

e/N

o:Ar

ea:

Cro

p:

Ergo

t:*

Pres

ent

/

N

ot P

rese

nt*D

elet

e as

app

ropr

iate

Har

vest

Dat

e:Fe

rtilis

er (i

nclu

ding

FYM

/slu

rry):

Hom

e Sa

ved

Seed

Ye

s / N

oPu

rcha

sed

Seed

Lot

Num

ber:

Varie

ty:

Seed

Trea

tmen

t:D

ate:

Rat

e:N

:P:K

Accu

mul

ativ

e N

itrog

en

Appl

ied

Soil

Type

:

Prev

ious

Cro

p:So

win

g D

ate:

Se

ed R

ate:

Cul

tivat

ions

:So

ilAn

alys

is:

pHP

KM

g

Dat

e:

*Com

post

/Dig

esta

te *

Del

ete

as a

ppro

pria

teO

rigin

and

Bat

ch

No:

Del

iver

y D

ate:

PAS:

Perm

it:Ap

plic

atio

n D

ate:

Appl

icat

ion

Rat

e:

N:P

:KAc

cum

ulat

ive

Nitr

ogen

Ap

plie

dSu

pplie

r:Su

pplie

r:

Oth

er A

pplic

atio

nsD

ate

appl

ied

Cro

p G

SR

easo

n fo

r tre

atm

ent

List

all

prod

ucts

ap

plie

dD

ose

Rat

eW

ater

Vo

lum

eSp

ray

Qua

lity

Win

d D

irect

ion

Win

d Sp

eed

Ope

rato

rSp

ray

time

star

t

fini

shC

ost

LER

AP( P

leas

e tic

k)

Pest

icid

e C

lass

ifica

tion

% D

ose

Rat

eSp

raye

r R

atin

gSi

ze o

f Wat

er C

ours

eSi

ze o

f Buf

fer Z

one

Dat

e of

Le

rap

Sign

atur

e

12

34

1m2m

3m4m

5m>

5m

1 =

Dry

Ditc

h

2 =

<3

m

3 =

3 -6

m

4 =

>6m

Dat

eap

plie

dC

rop

GS

Rea

son

for t

reat

men

tLi

st a

ll pr

oduc

ts

appl

ied

Dos

e R

ate

Wat

er

Volu

me

Spra

y Q

ualit

yW

ind

Dire

ctio

nW

ind

Spee

dO

pera

tor

Spra

y tim

est

art

fi

nish

Cos

t

LER

AP( P

leas

e tic

k)

Pest

icid

e C

lass

ifica

tion

% D

ose

Rat

eSp

raye

r R

atin

gSi

ze o

f Wat

er C

ours

eSi

ze o

f Buf

fer Z

one

Dat

e of

Le

rap

Sign

atur

e

12

34

1m2m

3m4m

5m>

5m

1 =

Dry

Ditc

h

2 =

<3

m

3 =

3 -6

m

4 =

>6m

Dat

eap

plie

dC

rop

GS

Rea

son

for t

reat

men

tLi

st a

ll pr

oduc

ts

appl

ied

Dos

e R

ate

Wat

er

Volu

me

Spra

y Q

ualit

yW

ind

Dire

ctio

nW

ind

Spee

dO

pera

tor

Spra

y tim

est

art

fi

nish

Cos

t

Har

vest

Yea

r ....

......

......

.FI

ELD

REC

OR

DFi

eld

Nam

e/N

o:Ar

ea:

Cro

p:

Ergo

t:*

Pres

ent

/

N

ot P

rese

nt*D

elet

e as

app

ropr

iate

Har

vest

Dat

e:Fe

rtilis

er (i

nclu

ding

FYM

/slu

rry):

Hom

e Sa

ved

Seed

Ye

s / N

oPu

rcha

sed

Seed

Lot

Num

ber:

Varie

ty:

Seed

Trea

tmen

t:D

ate:

Rat

e:N

:P:K

Accu

mul

ativ

e N

itrog

en

Appl

ied

Soil

Type

:

Prev

ious

Cro

p:So

win

g D

ate:

Se

ed R

ate:

Cul

tivat

ions

:So

ilAn

alys

is:

pHP

KM

g

Dat

e:

*Com

post

/Dig

esta

te *

Del

ete

as a

ppro

pria

teO

rigin

and

Bat

ch

No:

Del

iver

y D

ate:

PAS:

Perm

it:Ap

plic

atio

n D

ate:

Appl

icat

ion

Rat

e:

N:P

:KAc

cum

ulat

ive

Nitr

ogen

Ap

plie

dSu

pplie

r:Su

pplie

r:

Oth

er A

pplic

atio

nsD

ate

appl

ied

Cro

p G

SR

easo

n fo

r tre

atm

ent

List

all

prod

ucts

ap

plie

dD

ose

Rat

eW

ater

Vo

lum

eSp

ray

Qua

lity

Win

d D

irect

ion

Win

d Sp

eed

Ope

rato

rSp

ray

time

star

t

fini

shC

ost

LER

AP( P

leas

e tic

k)

Pest

icid

e C

lass

ifica

tion

% D

ose

Rat

eSp

raye

r R

atin

gSi

ze o

f Wat

er C

ours

eSi

ze o

f Buf

fer Z

one

Dat

e of

Le

rap

Sign

atur

e

12

34

1m2m

3m4m

5m>

5m

1 =

Dry

Ditc

h

2 =

<3

m

3 =

3 -6

m

4 =

>6m

Dat

eap

plie

dC

rop

GS

Rea

son

for t

reat

men

tLi

st a

ll pr

oduc

ts

appl

ied

Dos

e R

ate

Wat

er

Volu

me

Spra

y Q

ualit

yW

ind

Dire

ctio

nW

ind

Spee

dO

pera

tor

Spra

y tim

est

art

fi

nish

Cos

t

Har

vest

Yea

r ....

......

......

.FI

ELD

REC

OR

DFi

eld

Nam

e/N

o:Ar

ea:

Cro

p:

Ergo

t:*

Pres

ent

/

N

ot P

rese

nt*D

elet

e as

app

ropr

iate

Har

vest

Dat

e:Fe

rtilis

er (i

nclu

ding

FYM

/slu

rry):

Hom

e Sa

ved

Seed

Ye

s / N

oPu

rcha

sed

Seed

Lot

Num

ber:

Varie

ty:

Seed

Trea

tmen

t:D

ate:

Rat

e:N

:P:K

Accu

mul

ativ

e N

itrog

en

Appl

ied

Soil

Type

:

Prev

ious

Cro

p:So

win

g D

ate:

Se

ed R

ate:

Cul

tivat

ions

:So

ilAn

alys

is:

pHP

KM

g

Dat

e:

*Com

post

/Dig

esta

te *

Del

ete

as a

ppro

pria

teO

rigin

and

Bat

ch

No:

Del

iver

y D

ate:

PAS:

Perm

it:Ap

plic

atio

n D

ate:

Appl

icat

ion

Rat

e:

N:P

:KAc

cum

ulat

ive

Nitr

ogen

Ap

plie

dSu

pplie

r:Su

pplie

r:

Oth

er A

pplic

atio

nsD

ate

appl

ied

Cro

p G

SR

easo

n fo

r tre

atm

ent

List

all

prod

ucts

ap

plie

dD

ose

Rat

eW

ater

Vo

lum

eSp

ray

Qua

lity

Win

d D

irect

ion

Win

d Sp

eed

Ope

rato

rSp

ray

time

star

t

fini

shC

ost

LER

AP( P

leas

e tic

k)

Pest

icid

e C

lass

ifica

tion

% D

ose

Rat

eSp

raye

r R

atin

gSi

ze o

f Wat

er C

ours

eSi

ze o

f Buf

fer Z

one

Dat

e of

Le

rap

Sign

atur

e

12

34

1m2m

3m4m

5m>

5m

1 =

Dry

Ditc

h

2 =

<3

m

3 =

3 -6

m

4 =

>6m

Dat

eap

plie

dC

rop

GS

Rea

son

for t

reat

men

tLi

st a

ll pr

oduc

ts

appl

ied

Dos

e R

ate

Wat

er

Volu

me

Spra

y Q

ualit

yW

ind

Dire

ctio

nW

ind

Spee

dO

pera

tor

Spra

y tim

est

art

fi

nish

Cos

t

Har

vest

Yea

r ....

......

......

.FI

ELD

REC

OR

DFi

eld

Nam

e/N

o:Ar

ea:

Cro

p:

Ergo

t:*

Pres

ent

/

N

ot P

rese

nt*D

elet

e as

app

ropr

iate

Har

vest

Dat

e:Fe

rtilis

er (i

nclu

ding

FYM

/slu

rry):

Hom

e Sa

ved

Seed

Ye

s / N

oPu

rcha

sed

Seed

Lot

Num

ber:

Varie

ty:

Seed

Trea

tmen

t:D

ate:

Rat

e:N

:P:K

Accu

mul

ativ

e N

itrog

en

Appl

ied

Soil

Type

:

Prev

ious

Cro

p:So

win

g D

ate:

Se

ed R

ate:

Cul

tivat

ions

:So

ilAn

alys

is:

pHP

KM

g

Dat

e:

*Com

post

/Dig

esta

te *

Del

ete

as a

ppro

pria

teO

rigin

and

Bat

ch

No:

Del

iver

y D

ate:

PAS:

Perm

it:Ap

plic

atio

n D

ate:

Appl

icat

ion

Rat

e:

N:P

:KAc

cum

ulat

ive

Nitr

ogen

Ap

plie

dSu

pplie

r:Su

pplie

r:

Oth

er A

pplic

atio

nsD

ate

appl

ied

Cro

p G

SR

easo

n fo

r tre

atm

ent

List

all

prod

ucts

ap

plie

dD

ose

Rat

eW

ater

Vo

lum

eSp

ray

Qua

lity

Win

d D

irect

ion

Win

d Sp

eed

Ope

rato

rSp

ray

time

star

t

fini

shC

ost

LER

AP( P

leas

e tic

k)

Pest

icid

e C

lass

ifica

tion

% D

ose

Rat

eSp

raye

r R

atin

gSi

ze o

f Wat

er C

ours

eSi

ze o

f Buf

fer Z

one

Dat

e of

Le

rap

Sign

atur

e

12

34

1m2m

3m4m

5m>

5m

1 =

Dry

Ditc

h

2 =

<3

m

3 =

3 -6

m

4 =

>6m

Dat

eap

plie

dC

rop

GS

Rea

son

for t

reat

men

tLi

st a

ll pr

oduc

ts

appl

ied

Dos

e R

ate

Wat

er

Volu

me

Spra

y Q

ualit

yW

ind

Dire

ctio

nW

ind

Spee

dO

pera

tor

Spra

y tim

est

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fi

nish

Cos

t

Har

vest

Yea

r ....

......

......

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ELD

REC

OR

DFi

eld

Nam

e/N

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Cro

p:

Ergo

t:*

Pres

ent

/

N

ot P

rese

nt*D

elet

e as

app

ropr

iate

Har

vest

Dat

e:Fe

rtilis

er (i

nclu

ding

FYM

/slu

rry):

Hom

e Sa

ved

Seed

Ye

s / N

oPu

rcha

sed

Seed

Lot

Num

ber:

Varie

ty:

Seed

Trea

tmen

t:D

ate:

Rat

e:N

:P:K

Accu

mul

ativ

e N

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en

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ied

Soil

Type

:

Prev

ious

Cro

p:So

win

g D

ate:

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ed R

ate:

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tivat

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alys

is:

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KM

g

Dat

e:

*Com

post

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esta

te *

Del

ete

as a

ppro

pria

teO

rigin

and

Bat

ch

No:

Del

iver

y D

ate:

PAS:

Perm

it:Ap

plic

atio

n D

ate:

Appl

icat

ion

Rat

e:

N:P

:KAc

cum

ulat

ive

Nitr

ogen

Ap

plie

dSu

pplie

r:Su

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r:

Oth

er A

pplic

atio

nsD

ate

appl

ied

Cro

p G

SR

easo

n fo

r tre

atm

ent

List

all

prod

ucts

ap

plie

dD

ose

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eW

ater

Vo

lum

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ray

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lity

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d D

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ion

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d Sp

eed

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rSp

ray

time

star

t

fini

shC

ost

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leas

e tic

k)

Pest

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e C

lass

ifica

tion

% D

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Rat

eSp

raye

r R

atin

gSi

ze o

f Wat

er C

ours

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f Buf

fer Z

one

Dat

e of

Le

rap

Sign

atur

e

12

34

1m2m

3m4m

5m>

5m

1 =

Dry

Ditc

h

2 =

<3

m

3 =

3 -6

m

4 =

>6m

Dat

eap

plie

dC

rop

GS

Rea

son

for t

reat

men

tLi

st a

ll pr

oduc

ts

appl

ied

Dos

e R

ate

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er

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me

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y Q

ualit

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ind

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ctio

nW

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pera

tor

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y tim

est

art

fi

nish

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t

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vest

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r ....

......

......

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ELD

REC

OR

DFi

eld

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e/N

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Cro

p:

Ergo

t:*

Pres

ent

/

N

ot P

rese

nt*D

elet

e as

app

ropr

iate

Har

vest

Dat

e:Fe

rtilis

er (i

nclu

ding

FYM

/slu

rry):

Hom

e Sa

ved

Seed

Ye

s / N

oPu

rcha

sed

Seed

Lot

Num

ber:

Varie

ty:

Seed

Trea

tmen

t:D

ate:

Rat

e:N

:P:K

Accu

mul

ativ

e N

itrog

en

Appl

ied

Soil

Type

:

Prev

ious

Cro

p:So

win

g D

ate:

Se

ed R

ate:

Cul

tivat

ions

:So

ilAn

alys

is:

pHP

KM

g

Dat

e:

*Com

post

/Dig

esta

te *

Del

ete

as a

ppro

pria

teO

rigin

and

Bat

ch

No:

Del

iver

y D

ate:

PAS:

Perm

it:Ap

plic

atio

n D

ate:

Appl

icat

ion

Rat

e:

N:P

:KAc

cum

ulat

ive

Nitr

ogen

Ap

plie

dSu

pplie

r:Su

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r:

Oth

er A

pplic

atio

nsD

ate

appl

ied

Cro

p G

SR

easo

n fo

r tre

atm

ent

List

all

prod

ucts

ap

plie

dD

ose

Rat

eW

ater

Vo

lum

eSp

ray

Qua

lity

Win

d D

irect

ion

Win

d Sp

eed

Ope

rato

rSp

ray

time

star

t

fini

shC

ost

LER

AP( P

leas

e tic

k)

Pest

icid

e C

lass

ifica

tion

% D

ose

Rat

eSp

raye

r R

atin

gSi

ze o

f Wat

er C

ours

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ze o

f Buf

fer Z

one

Dat

e of

Le

rap

Sign

atur

e

12

34

1m2m

3m4m

5m>

5m

1 =

Dry

Ditc

h

2 =

<3

m

3 =

3 -6

m

4 =

>6m

Dat

eap

plie

dC

rop

GS

Rea

son

for t

reat

men

tLi

st a

ll pr

oduc

ts

appl

ied

Dos

e R

ate

Wat

er

Volu

me

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y Q

ualit

yW

ind

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ctio

nW

ind

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dO

pera

tor

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y tim

est

art

fi

nish

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t

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vest

Yea

r ....

......

......

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ELD

REC

OR

DFi

eld

Nam

e/N

o:Ar

ea:

Cro

p:

Ergo

t:*

Pres

ent

/

N

ot P

rese

nt*D

elet

e as

app

ropr

iate

Har

vest

Dat

e:Fe

rtilis

er (i

nclu

ding

FYM

/slu

rry):

Hom

e Sa

ved

Seed

Ye

s / N

oPu

rcha

sed

Seed

Lot

Num

ber:

Varie

ty:

Seed

Trea

tmen

t:D

ate:

Rat

e:N

:P:K

Accu

mul

ativ

e N

itrog

en

Appl

ied

Soil

Type

:

Prev

ious

Cro

p:So

win

g D

ate:

Se

ed R

ate:

Cul

tivat

ions

:So

ilAn

alys

is:

pHP

KM

g

Dat

e:

*Com

post

/Dig

esta

te *

Del

ete

as a

ppro

pria

teO

rigin

and

Bat

ch

No:

Del

iver

y D

ate:

PAS:

Perm

it:Ap

plic

atio

n D

ate:

Appl

icat

ion

Rat

e:

N:P

:KAc

cum

ulat

ive

Nitr

ogen

Ap

plie

dSu

pplie

r:Su

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r:

Oth

er A

pplic

atio

nsD

ate

appl

ied

Cro

p G

SR

easo

n fo

r tre

atm

ent

List

all

prod

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ap

plie

dD

ose

Rat

eW

ater

Vo

lum

eSp

ray

Qua

lity

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d D

irect

ion

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d Sp

eed

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rato

rSp

ray

time

star

t

fini

shC

ost

LER

AP( P

leas

e tic

k)

Pest

icid

e C

lass

ifica

tion

% D

ose

Rat

eSp

raye

r R

atin

gSi

ze o

f Wat

er C

ours

eSi

ze o

f Buf

fer Z

one

Dat

e of

Le

rap

Sign

atur

e

12

34

1m2m

3m4m

5m>

5m

1 =

Dry

Ditc

h

2 =

<3

m

3 =

3 -6

m

4 =

>6m

Dat

eap

plie

dC

rop

GS

Rea

son

for t

reat

men

tLi

st a

ll pr

oduc

ts

appl

ied

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e R

ate

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er

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me

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y Q

ualit

yW

ind

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ctio

nW

ind

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dO

pera

tor

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y tim

est

art

fi

nish

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t

SQC

Gra

in M

ovem

ent R

ecor

d

Dat

eC

omm

odity

Bio-

fuel

Ap

prox

. To

nnag

eM

erch

ant

Hau

lier

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istra

tion

No.

Load

er

Sig

natu

reD

river

S

igna

ture

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es

SQC

Gra

in M

ovem

ent R

ecor

d

Dat

eC

omm

odity

Bio-

fuel

Ap

prox

. To

nnag

eM

erch

ant

Hau

lier

Reg

istra

tion

No.

Load

er

Sig

natu

reD

river

S

igna

ture

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es

SQC

Gra

in M

ovem

ent R

ecor

d

Dat

eC

omm

odity

Bio-

fuel

Ap

prox

. To

nnag

eM

erch

ant

Hau

lier

Reg

istra

tion

No.

Load

er

Sig

natu

reD

river

S

igna

ture

Not

es

SQC

–M

embe

r’s C

ompl

aint

s R

egis

ter

-If n

o co

mpl

aint

s re

ceiv

ed, c

ompl

ete

Sec

tion

2

Sect

ion

1

Nam

e an

d ad

dres

s of

Com

plai

nant

Dat

e re

ceiv

edN

atur

e of

com

plai

ntPr

opos

ed c

orre

ctio

n ac

tion

Dat

e ac

tion

finis

hed

Eg. G

rain

Com

pany

,

D

ock

1

Th

e Ke

ys09

/09/

12Sa

w to

oth

grai

n be

etle

Trea

t gra

in w

ith R

elda

n 22

12/0

9/12

Sect

ion

2

Har

vest

Yea

r:N

o C

ompl

aint

s R

ecei

ved

Sign

atur

e:D

ate:

Har

vest

Yea

r:N

o C

ompl

aint

s R

ecei

ved

Sign

atur

e:D

ate:

Notes

NOTES