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. 1. NAME 4NJD ADDRESS of landowner or person for whom the pesticide was applied. <br />2. YEAR 0011 MONTH <br />3. Weather Conditions Clear Cloudy I <br />Estimated Wind Speed and Direction 0 — 3 m pi 'U luE <br />Estimated Temperature (00 <br />4. LOCATION of pesticide application (County Road Number, State Hwy., Sec, Tnshp, & Range, <br />etc) Location of Farm or Ranch. (Be as specific as possible). <br />7' '7 990.7 Sec, 17 <br />G-rauci pf 4= m- i09 — o .3 <br />5. Target Weed or Pest. (Name of w ed or pest, such as Leafy Spurge, or Wyoming Ground <br />Squirrel). S a,(+ (P4c r <br />6. S ific crop or commodity to vyhich pesticide was applied. (Roadside, Pasture, etc.) <br />D ec r C \ tta e, 11%.) RI r ei. <br />7. Trade Name of Pesticide A a L t40, -f <br />E.P.A. Registration No. eQ q I 1 /0 <br />E.P.A. Establishment No. L/ / — PR UG a. <br />Chemical Lot No. 9-as <br />8. Ap; t lic tioi rate of,ch emical(s) applied ( ordon 22K -1 qt. /acye). <br />Q a �- N T S / y % 1 n ) 11/4.) a, e r— <br />S raLs 1'0 U- el <br />9. Gallons used <br />11. Operator of truck, Signature <br />MOFFAT COUNTY PEST MANAGEMENT <br />..d+E,t es- treated p la as_ <br />10. Type and amount if pesticide disposed of, method of disposal, date or dates of disposal and location <br />of disposal site. (Tordon 22K, 2 mpty 5 gallon cans, July 10, 1990, triple rinsed, Moffat County <br />Sanitary Land Fill). A/ <br />DATE 3 TIME OF APPLICATION <br />