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Os orn <br />Industries LLC <br />Date: n i <br />�_of <br />Job Name: �C' ,�Y11 � --J <br />Address: <br />Equipment working properly <br />Hoses serviceable <br />Pumps serviceable <br />Filters serviceable <br />Tanks secured properly <br />Proper PPE available <br />l� <br />U" <br />V j <br />Location Contact k1fo: <br />�( <br />j( - 1.3 ;1 - fit? <br />. <br />Notes: <br />A(-�� <br />_ i I y v <br />0 ill od S Z - )I LL -L 1 �j <br />Temperature <br />G' J <br />Wind <br />Direction <br />Conditions <br />Spraying Time <br />Targeted Species <br />Type of Site Treated: Rangeland ndustri I <br />Ag Crop ROW Turf <br />Chemical Name <br />EPA Reg # Applied Amount / Acre <br />Total Product Applied <br />- <br />C pL <br />pl- <br />Y':t <br />i 1() C' <br />Method of Application ATV UTV ; Truck Tractor Backpack Horse Other <br />Gallons per acre: Dilution used: VJX-t Number of Applicators: ` — <br />Truck Number: ATV/UTV number: Billable Hours ] . 3L)r� - (�I - S <br />r �l t�C�l 17 v <br />V^ C)C rw III I r. (, )'V'v i Z t -)7- <br />13 <br />-)7.. <br />Qualified Supervisor: <br />ApplicatoG <br />1'J G -%. 1 1--i L -Vv -&t 4 12; 1 -� 0 2. <br />Date & 1-1 <br />Date /) , , h a [a k <br />CZer(c-ial ` <br />ricators <br />Com app are licensed by the Colorado Department of Agriculture <br />