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0S O rn <br />Industries LLC <br />Date: - �' I � T-77of <br />q <br />Job Name: L(jM, LE <br />Address: <br />Equipment working properly <br />Hoses serviceable�'�� <br />Pumps serviceable <br />Filters serviceable <br />Tanks secured properly <br />Proper PPE available <br />c <br />Location Contact info: <br />��tiWcak <br />Notes: <br />C ���' <br />CJ !J <br />Temperature <br />:�L <br />Wind <br />`1� ')c <br />Direction <br />,r k <br />Conditions <br />cv <br />Spraying Time <br />Targeted Species <br />Type of Site Treated: Rangeland industrial ? <br />Ag Crop ROW Turf <br />Chemical Name <br />EPA Reg # <br />Applied Amount / Acre <br />Total Product Applied <br />C -• ;)1J.:,)2- <br />VU k <br />��>z <br />7C <br />Cl,),.,, <br />3-'Z'(wl <br />Z, I <br />Method of Application ATV UTV Truck ' <br />Tractor Backpack Horse Other <br />Gallons per acre: lC- Dilution used: <br />Truck Number: ; ATV/UTV number: - <br />Number of Applicators - <br />Billable Hours �, '�, - 5hi� X2 <br />�- lOhc, <br />Cl <br />Qualified Supervisor <br />Applicator <br />Commercial applicators are licensed by the Colorado Department of Agriculture <br />