Page 267 - AG 7-2011 Revised 2016

P. 267

STATE OF CALIFORNIA PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT

DEPARTMENT OF PESTICIDE REGULATION
DPR-PML-017C (REV. 08/15) Page 1 of2

Submit to the Agricultur al Commissioner within 1 O days of the month following application.

Month 1 Year 2

Operator ID/Permit No. perator (Grower) ddress City Zip Code
1: 1:
7
s otal Planted Acres/Units County Number Section Township 6 Range Base & Meridian
Site Identification No. I: ! 11 ! I
Field Location 12 os 13 140 s O M
8 10 ON DE Ow DH

Commodity/ Site Treated

15 16

Date/Time Acreage/ Pre-plant Application Method Block ID EPA or State Registration Number Total Product Used Days Rate Dilution Product and Manufacturer
Application Units ?1 (If Applicable) '?7
17 Completed 18 Treated (If Applicable) (Check One) (From Label) '?, l?teentry ,J'er Acre ?6
rn ?O ?)

0Ground

D OAir DODD D
0Fume LB OZ PT QT GP.

Dother--
0Ground