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Os rn <br />Industries LLC <br />Date: - 113 -1 X -"T- <br />_Lof�_ <br />Job Name:- �2: rl <br />t <br />Address: <br />Equipment working properly <br />Hoses serviceable <br />Pumps serviceable <br />Filters serviceable <br />Tanks <br />Tanks secured properly <br />Proper PPE available <br />/ <br />L/ <br />l/ <br />L11 - <br />t/ <br />✓ <br />Location Contact info: <br />� Y -3-n A o, <br />Notes: <br />Temperature <br />Wind <br />Direction <br />Conditions <br />Spraying Time <br />in IS ( zo <br />Targeted Species -' �, '10 4 i <br />V1 <br />Type of Site Treated: Rangeland ndustri <br />Ag Crop ROW <br />Turf <br />Chemical Name <br />EPA Reg # <br />Applied Amount / Acre <br />Total Product Applied <br />6-4 <br />Method of Application ATV -LLPol - Truck Tractor Backpack Horse <br />Other <br />Gallons per acre: Dilution used: Q(.,Acr' <br />Truck Number: 5 ATV/UTV number: <br />Truck <br />Number of Applicators: 2 - <br />Billable Hours 9'- 3O - 1 '. 3U = rs <br />i& , , L -,A , . t + hcaA i k4o J L,,L, t1 <br />Qualified Supervisor: <br />Applicator: <br />Commercial applicators are licensed by the Colorado Department of Agriculture <br />