69
52
X
2
NW
DAILY
PESTICIDE
REPORT
(M&R-629)
PAGE
2
of
2
MATERIAL
MASTER
CODE
&
EPA
REGISTRATION
NUMBER
JOB
A
RATE
RATE
RATE
RATE
CONC.
CONC.
CONC.
CONC.
JOB
B
JOB
C
JOB
D
TEMP
TIME
OF
DAY
CLEAR
CLOUDY
RAIN
SPEED
WIND
DIR
WEATHER
CONDITIONS
RATE
AND
CONCENTRATION:
DESCRIPTION
OF
SPRAYING
#
57020293
Herbicide,
Roundup
Pro
-
#524-475
2
qt./acre
FACILITY
ADDRESS:
TRAINED
SERVICEPERSON'S
NAME:
SERVICEPERSON
SIGNATURE:
APPLICATOR'S
NAME
&
LIC.
#:
APPLICATOR'S
SIGNATURE:
ADDITIONAL
COMMENTS:
GUARDRAIL
/
SIGNPOST
JOHNSON
GRASS
NOXIOUS
WEEK
BRUSH
CONTROL
BROADCAST
SPRAY
INSECTICIDES
CUT
STUMP
MISCELLANEOUS
MORNING
MIDDAY
AFTERNOON
