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Os O rn <br />Industries LLC <br />Date: <br />Job 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 />t� <br />Notes: <br />Temperature <br />Wind <br />Direction <br />Conditions <br />Spraying Time <br />Targeted Species L, ; <br />Type of Site Treated: Rangeland Q Industrial <br />Ag Crop ROW Turf <br />Chemical Name <br />EPA Reg # <br />Applied Amount / Acre <br />Total Product Applied <br />C', /7 <br />Method of Application ATV UTV Truck <br />Tractor Backpack Horse Other <br />Gallons per acre: < Dilution used: ' <br />Truck Number: ATV/UTV number: <br /><<<I f" Number of Applicators: <br />Billable Hours <br />Qualified Supervisor: <br />Applicator: uate <br />Commercial applicators are licensed by the Colorado Department of Agriculture <br />