SOW_Attachment_A_-__Sample_Pesticide_Application_Record.pdf

Per BLM policy, Pesticide Application Records must be completed within 24 hours of pesticide application.

Pesticide Application Record (PAR) BLM Project Name:________________________________

Bureau of Land Management Elko District Operator:_________________________________________

3900 Idaho St Elko, NV 89801 Contract Number: _________________________________

Acres Treated:_____________________________________

TREATMENT INFORMATION

Treatment Date:

Start Time:

End Time:

Weather Reading (START) Temperature (F):

Wind Speed: Wind Direction:

Relative Humidity:

Weather Reading (END) Temperature (F):

Wind Speed: Wind Direction:

Relative Humidity:

Sprayer Calibration Rate:

(equipment output, ex: 8 GALLONS/ACRE)

Spray Pattern

(circle one)

BROADCAST – SPOT

Application Equipment Used:

Total Amount of Mixture Applied (in gallons):

Number of Loads:

Licensed Applicator Name, Applicator’s Nevada License Number, AND Crew Members:

CHEMICAL BRAND(s) APPLIED - In formulated product units

CHEMICAL TRADE

NAME (ex: Roundup

Pro, Overdrive)

MANUFACTURER

(ex: MONSANTO, BASF)

EPA REG #

(ex: 524-475, 7969-150)

CHEMICAL

COMMON NAME

(ex: Glyphosate, Dicamba + Diflufenzopyr)

RATE OF APPLICATION

Liquid ex: 2 QUARTS PER ACRE, , 8 FLUID OUNCES

PER ACRE, 1 PERCENT SOLUTION

Dry ex: 0.50 POUND PER ACRE, 1 OUNCE PER ACRE

ADJUVANTS BRAND(s) APPLIED - In formulated product units

ADJUVANT BRAND NAME

(ex: DYNE_AMIC)

MANUFACTURER

(ex: HELENA CHEMICAL)

RATE OF APPLICATION

Liquid ex: 2 QUARTS PER ACRE, , 8 FLUID OUNCES PER ACRE, 1 PERCENT SOLUTION Dry ex: 0.50 POUND PER ACRE, 1 OUNCE PER ACRE

NOTES/COMMENTS: