Exhibit 3 - AGO Form 200-1-16 Pesticide Reporting Form.pdf

This document is an AGO Form 200-1-16 Pesticide Application Record dated 17 June 2019, which serves as a standardized form for documenting pesticide application details. The form is designed to capture comprehensive information about a specific pesticide application, including location, weather conditions, application time, pesticide details, and application method. Key fields include space for recording the job number, facility, application date, pesticide name, EPA registration number, active ingredients, total amount applied, and the method of application.

The form provides a structured template for professional pest control documentation, requiring detailed information such as estimated square footage of the treated area, specific pests being controlled, wind and temperature conditions, and the license numbers of the pesticide applicators. While the form is blank in this instance, it is clearly intended to create a thorough and systematic record of pesticide use, likely for regulatory compliance, safety tracking, and maintaining a historical log of pest control activities. The form's design suggests it is used by government agencies or organizations that require meticulous tracking of pesticide applications.