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MOFFAT COUNTY PEST MANAGEMENT <br />1. NAME AND ADD �Y SS of landow r or person fo whom the pesticide was applied. <br />oaf 1, t <br />toe At t <br />2. YEAR �3 MONTH DATE TIME OF APPLICATION <br />3. Weather Conditions Clear Cloudy <br />Estimated Wind Speed and Direction <br />Estimated Temperature <br />4. Was visual monitoring performed during application? / Yes No <br />If no, give reason monitoring was not done <br />5. LOCATION of pesticide application (County Road Number, State Hwy., Sec, Tnshp, & Range, <br />etc) Loca�,ion o Farm or Ranch. (Be as specific as possible). <br />%- Cf q O 15'=c n 9( SCNIL <br />v <br />6. Target Weed or Pest. (Name of weed or pest, such as Leafy Spurge, or Wyoming Ground <br />Squirrel). <br />7. Speecific crop or commodity to which pesticide was applied. (Roadside, Pasture, etc.) <br />8. Trade Name of Pesticide <br />E.P.A. Registration No. <br />E.P.A. Establishment No. / <br />Chemical Lot No. <br />9. Application rate of chemical(s) applied (Tordon 22K -1 qt. /acre). <br />10. Gallons used Acres treated <br />11. Type and amount if pesticide disposed of, method of disposal, date or dates of disposal and location <br />of disposal site. (Tordon 22K, 2 empty 5 gallon cans, July 10, 1990, triple rinsed, Moffat County <br />Sanitary Land Fill). <br />12. Operator of truck, Signature cre <br />PM- Fnrmc• Treat —ant 1— <br />