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Os rn <br />Industries LLC <br />Date: ,- <br />' ! ) (, <br />�_of <br />Job Name: <br />+' \% <br />Address: <br />Equipment working properly <br />Hoses serviceable <br />Pumps serviceable <br />Filters serviceable <br />Tanks secured properly <br />Proper PPE available <br />I <br />Location Contact info: <br />\ <br />Notes: <br />Temperature <br />Wind <br />Direction <br />Conditions <br />Spraying Time <br />Targeted Species <br />Type of Site Treated: Rangeland tai--- <br />Ag Crop <br />ROW Turf <br />Chemical Name <br />EPA # <br />Applied Amount / Acre <br />Total Product Applied <br />(Reg <br />Method of Application ATV UTV Truck <br />Tractor Backpack <br />Horse Other <br />Gallons per acre: Dilution used: Number of Applicators: <br />Truck Number: 1 ATV/UTV number: Billable Hours 3, ) <br />��it;i+) `�;'t�EtY E �t,i�l "1t'�{,� ✓ t,;;�f;' ��t' . i ', _� ,�i -:;, i _ (,;, <br />Qualified Supervisor: t//. j(/� ��.." �" _ Date <br />Applicator: / �(r1c' Q�'iL,V_ t 111 Date <br />CommWccial applicators are licensed by the Colorado Department of Agriculture <br />