Attachment 5_Herbicide Daily Log.pdf

ATTACHMENT 5-: Daily Herbicide Treatment Reporting Form

USDA Forest Service, Region 9 Date:____________ Sheet:____ of _____

State/County:___________________ Wayne National Forest Contractor Information (if applicable) Daily Log – Pesticide Application Stand treated: ____________

Acres Treated: ___________

Name: ___________________________ Type of Application: Applicator/Operator (print): License No:

Address: _________________________ Hack/Squirt ________________________ ___________

_________________________________ Foliar ________________________ ___________ Phone: ______________________ Bark/Stump Application ________________________ ___________

E Weather Start End Target Species - Common

Name/Scientific Name Monitoring Notes

Date___________ Observer_________

Time

1.

Wind Velocity (mph)

2.

Wind Direction: (N NE E SE S SW W NW)

3.

Temperature (F°)

4.

Precipitation (inches)

5.

Condition [S-sun] [C-cloudy] [PC-partly cloudy]

6.

CHEMICAL AND ADJUVANT SUMMARY (* if not applicable to adjuvants) Common Name

(e.g. Glyphosate) Commercial Formulation (e.g. Round

Up Pro)

*EPA

Reg. #r

*Restricte d

Use Pesticide

(Y/N)

*% Active Ingredient (AI) in formulation

(lbs./gal)

*Carrie r/

Dilutan t

Ounces of produc t used

*Applicatio n Rate 1:

Formulation in Tank Mix*

*Applicatio n Rate 2:

lbs.

AI/Acre*

Adjuvant /gallon

*Total Volume Applied:

Gallons

Tank Mix

*Total AI applied (lbs. AI)