Required by most labels. File for at least 3 years.
Date: Applicator: Cert #:
Start time: End time: Temp (F): Wind (mph): Direction:
Weather forecast next 24h:
| Field | Value |
|---|---|
| Product name | |
| EPA Registration # | |
| Active ingredient(s) | |
| Rate (per acre or per 100 gal) | |
| Concentration in tank | |
| Tank size (gal) | |
| Total tank mix volume (gal) | |
| Water source | |
| Surfactant / adjuvant | |
| REI (re-entry interval, hr) | |
| PHI (pre-harvest interval, days) |
| Block | # trees | Variety | Acres | Notes |
|---|---|---|---|---|
☐ Respirator ☐ Goggles ☐ Chemical-resistant gloves ☐ Coveralls ☐ Boots ☐ Apron
Signed: Date: Initials: