Attachment No. 3 Herbicide Application Record.pdf

Project Name: _ _

HERBICIDE APPLICATION RECORD

Unit No. (attach map): _N/A_ Comp/Stand:

Equipment Used: _ (e.g. backpack sprayer, tractor)

Application Method: _ (e.g. foliar, basal bark, cut stump)

Purpose / Target: _ _ (e.g. release/maple, invasive/kudzu)

Pesticide Name EPA Reg. No. Dilutant % Pesticide

Work Date

Lowest Temp during work

Highest Temp during work

Max. wind speed / direction

Mixture applied

(gallons)

Acres treated

Remarks Shapefile or Unit Name

Total for this Unit =

Certified Applicator in Charge:

Name:

Phone No.

KY License No: Expiration Date:

Prepared By, Signature: Date: Title:

Unit Completion Date: (or as listed above)