Daily_Log__Herbicide_Use_Revised_2014 1 .doc

DAILY HERBICIDE APPLICATION RECORD—Revised for 2014 Operator’s Name: ____________________________License #: _________________ Address: ___________________________________ Phone#: _______________________ Customer: FLATHEAD NATIONAL FOREST Ranger District: ________________ Customer contact address: 650 Wolfpack Way, Kalispell, MT 59901 (406) 758-3510 Shaded section to be filled out by USFS

FACTS ID: Subunit:

LOCATION(s): Include Road#, Landmark, Fire name, etc:

Note: If multiple roads are shown on one record, please list road numbers and approximate gallons for each road in comments below.

Jobcode:

TIMBER SALE or PROJECT NAME:

Prehaul Posthaul

DATE: NAME(s) of applicator(s):

COUNTY: Flathead Lake Missoula Powell Lewis & Clark

TIME:

START: STOP:

TEMPERATURE: Wind a.m. DRY: WET: %RH: DP: Speed: Direction: .

Wind p.m. DRY WET: %RH: DP: Speed: Direction:

.Check beside herbicide(s) used. If using generics, enter manufacturer’s name and EPA Reg #

Other (Specify):

HERBICIDE CONCENTRATE USED: Ounces cc

(circle one) MIXED HERBICIDE USED: Ounces Gallons (volume applied) (circle one)

RATE: Amt Concentrate per acre / Number of gal. water/acre:

/ Gal. Water/Acre BROADCAST SPOT SPRAY WICK (circle one)

ADJUVANT: Surf-Ac 910 Induce Activator90 Liberate Preference Other (specify):

Adjuvant Concentrate Used: Ounces cc

Type of area (ROW, campground, etc):

GROWTH STAGE(s): Rosette Bolt Bud

Flower Seed

EQUIPMENT USED:

ACRES SPRAYED (wetted): TARGET ACRES (size of overall area):

COMMENTS :

CONTINUE TO BACK PAGE

LOCATION 1: If not near a major landmark, please attach a map___________________________ TARGET AREA _______________________________ Acres Miles (circle one)

FS use

Forest Service use only

Inspected by________________

Other:

LOCATION 2 (optional): __________________________________

TARGET AREA _______________________________ Acres Miles (circle one)

FS use

Forest Service use only

Inspected by________________

Other:

Forest Service Use