Attachment_2_Lolo_submital.pdf

AG-03R6-S-13-0024 Attachment 2 Page 1 of 2

Lolo National Forest

DAILY PESTICIDE APPLICATION RECORD

Mike Mueller 101899-15 408 Clayton Plains/TFalls R.D. Plains, MT 59859 (406) 826-4353

BEFORE spraying fill-in blocks 1-13. FUND CODE: ____________

AFTER spraying start with block 16 and work your way back up to block 13 Circle/Fill-in Appropriate Response

County (9) Time

______Start ______Finish

(1) Contractor

Name

(10) Temp. _____° F

(2) Method Code

Manual Chem. (710), Mech. Chem. (720), Aerial Chem. (730)

(11) Wind speed

/Direction

(from)

____MPH (N, NE, E, SE,

S, SW, W, NW)

(3) Equipment

Code

Handsprayer (711)

Backpack (712)

Hand Spreader (714)

Mobile Grnd Sprayer (721)

Aerial (731)

(12) Pesticide

1 Carbaryl 4L

Sevin

2 B. t. (Bacillus thuringiensis)

Dipel Pro

3 Chlorothalonil

Quali-Pro

(4) Treatment

Type Pesticide (P)

(13) Product

Rate/Ac.

_____Gal/Ac

(1st pesticide from

#12 above)

_____Gal/Ac

(2nd pesticide from

#12 above)

(5) Trees

Ponderosa Pine, Lodge Pole

Pine, Western White Pine, White

Bark Pine, Douglas Fir, Western

Larch, Sub Alpine Fir, Grand

Fir, Engelmann Spruce

(14) Area Treated

(Ac.)

_____Ac.

(6) N/A

(15) Calibrated

Volume

(Gal Water/Ac.)

_____ gal/Ac

(7) Site

Admin, Campgrnd, Forest, Irrigation ditch, Pasture, Rangeland, Right-of-Way, Riparian, Trailhead, Trail

(16) Total gallons

Diluent Applied

_____ gal

(From flow meter or graduations on tank)

(8) Date: ____/____/20____ Comments:

Surfactant/Adjuvant: Ingredient Type: Rate Applied

(oz/ac):

AG-03R6-S-13-0024 Attachment 2 Page 2 of 2

Lolo National Forest

DAILY PESTICIDE APPLICATION RECORD CONT.

FACTS ID: ________________________________ District Number:__________

If Hourly Rate Applicable: Start Time:___________________ End Time: ___________________

Number of working crew members:_________________________

TIME

TEMP/

RH

WIND

SP/DIR.

BEGINNING

LAT./LONG.

ENDING

LAT./LONG. REMARKS

Comments:

Map: