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Pesticide Record Keeping Form  (Example)

Farm Name __________________________________________________
 Field I.D. ____________________________________________________
 Legal Description ______________________________________________
 Applicator/Supervisor  __________________________________________
 Certification Number  ___________________________________________

Pesticide Applications

Application 
Date		          
Crop/Location 
Treated		          
Size of 
Treated Area		          
Product Name           
EPA 
Registration 
No.		          
Total Amount 
of Product 
Applied		          
NOTES: 

 
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