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s 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 />✓ <br />`� <br />✓ <br />L/ <br />Location Contact info: <br />14kir, K�A kac�JC �- <br />Notes: <br />20cm-,e Eulbs4 %'a-� <br />Temperature <br />75 <br />Wind <br />tvw- <br />Direction <br />Conditions <br />Spraying Time <br />- <br />Targeted Species <br />Type of Site Treated: Rangeland Industrial <br />Ag Crop <br />ROW Turf <br />Chemical Name <br />EPA Reg # <br />Applied Amount / Acre <br />Total Product Applied <br />( <br />76Z <br />v l7 <br />D <br />3o i <br />31 <br />I <br />— <br />q lmtl <br />c -Z <br />Method of Application ATV UTV Truck <br />Tractor Backpack <br />Horse Other <br />Gallons per acre: 100 Dilution used: (00.4- <br />Truck Number: 5- ATV/UTV number: — <br />Number of Applicators: Z #01" <br />Billable Hours 30 - qL1 u - 3-, t) x2 17 <br />Qualified Superviso <br />Applicato <br />Commercial applicators are licensed by the Colorado Department of Agriculture <br />