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0 S rn <br />Industries LLC <br />Date: • 7- <br />of <br />lob Name: <br />Address: <br />Equipment working properly <br />Hoses serviceable <br />Pumps serviceable <br />Filters serviceable <br />Tanks secured properly <br />Proper PPE available <br />Location Contact info: <br />P <br />No es: <br />Temperature <br />IU <br />Wind <br />�!G tti ^�- <br />Direction <br />`' <br />Conditions <br />�.., l� :c! <br />Spraying Time <br />•lS - 'cam-; <br />Targeted Species <br />Type of Site Treated: Rangeland Industr' <br />Ag Crop ROW Turf <br />Chemical Name <br />EPA Reg # <br />Applied Amount / Acre <br />Total Product Applied <br />3<<70-1-/2j" <br />, t <br />L11, }(Al <br />LT <br />7Jaz <br />Method of Application ATV U Truck <br />Tractor Backpack Horse Other <br />Gallons per acre: �1,,' Dilution used: <br />Truck Number: ATV/UTV number: <br />Number of Applicators: Z <br />Billable Hours, UG �6 <br />Qualified Supervisor: <br />Appli <br />v` r )JJ <br />Commercial applicators are licensed by the Colorado Department of Agriculture <br />