Crop or Site: 2026

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The document is a Pesticide Record Keeping Form designed for private applicators to record essential information regarding the application of Restricted Use Pesticides (RUP). It outlines required details such as applicator name, certification number, application date, brand name, EPA registration number, location, crop treated, acres treated, and total pesticide amount. Additionally, it includes optional information for compliance with Worker Protection Standards (WPS), such as application times and active ingredients. Records must be maintained for two years and updated within 14 days of application.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in the 'Location' field, specifying where the pesticide application took place. This is crucial for compliance.
In the 'Crop or Site:' section, clearly indicate the specific crop or site treated. This information is essential for accurate record keeping.
Next, enter your name and certification number in the 'Applicator Name' and 'Certification #' fields respectively. Ensure these details are correct as they are mandatory for each application.
Fill in the 'Application Date' with the exact date of pesticide application, following the format provided.
Complete the remaining fields such as 'Brand Name', 'EPA Registration #', and details about acres treated and total amount used. These entries are vital for both RUP and WPS compliance.

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