Pesticide Application Records

Grower/Farm Name:

Field Name or Number:

Crop:

Address:

Physical Location of Field:

Variety:

Irrigation Type:

Previous crop:

State:

County:

Total Acres:

Soil Type:

REQUIRED INFORMATION

Target Pest

Product Name

EPA Reg. #

Active Ingredient

Time Applied (hr:min)

Date Applied (dd/mm/yr)

Total Amount of Product

Wind Speed & Direction

Temp.

Acres Treated

Applicator Name and License #

REI