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The document is a Commercial Applicator Pesticide Use Summary Report that must be submitted by certified supervisors detailing pesticide applications made in the previous calendar year. It includes sections for supervisor and business information, reporting period, certified applicator details, pesticide usage data, and a certification of accuracy. The report is required to be submitted by January 31st each year.

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Click ‘Get Form’ to open the ct form pesticide in the editor.
Begin with Part I by entering the Certified Supervisor Information. Fill in your name, mailing address, city/town, business phone, state, zip code, fax number, email, and certification numbers. Ensure all fields marked with an asterisk are completed.
Proceed to Part II: Reporting Period. Specify the reporting period for pesticide usage by entering the start and end dates. If another supervisor has reported usage, check the appropriate box and provide their name and certification number.
In Part III, enter the Certified Applicator’s Information including their name and certification number.
For Part IV: Commercial Pesticide Usage, list each pesticide product used along with its EPA registration number and total amount used before diluting. Check if additional sheets are needed.
Finally, complete Part V by certifying the accuracy of the information provided. Sign and date where indicated.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are 5 examples of pesticides?

Pesticides (chemicals used for killing pests, such as rodents, insects, or plants) 2,4-Dichlorophenoxyacetic Acid (2,4-D) Aldrin/Dieldrin. Atrazine. Chlordane. Chlordecone. DDT, DDE, DDD. Endosulfan. Endrin.

What are the forms of pesticide application?

Several types of pesticide application equipment are used, including liquid pumps (manual and power operated), liquid atomizers (hydraulic energy, gaseous energy, and centrifugal energy), dry application, and soil application (liquid injection application).

What is a Section 3 pesticide?

Registration: Under Section 3 of FIFRA, we can register pesticides for use throughout the United States. We register some pesticides for more limited use in certain states. In addition, states, tribes and territories can place further restrictions on pesticides used or sold within their own jurisdictions.

What is a form of pesticide?

About pesticides Examples include insecticides, fungicides, herbicides, molluscicides, and plant growth regulators. They can exist in many forms, such as solid granules, powders or liquids and consist of one or more active substances co-formulated with other materials.

How to apply pesticides correctly?

Plant Protection: How to Use Pesticides Appropriately Correctly identify insect and mite pests. Thoroughly cover all plant parts with spray solutions. Time pesticide applications ingly. Monitor water quality. Rotate pesticides with different modes of action. Apply pesticides frequently enough.

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What is considered a pesticide?

Chlorpyrifos, an organophosphate insecticide, is the most widely used insecticide in the U.S. It is used both in agriculture and for pest control in houses and other buildings. Americans are widely exposed to chlorpyrifos. Typical diets, particularly those of children, contain significant chlorpyrifos residues.

What are the 3 of the forms pesticides come in?

Soluble - Able to be dissolved in another substance, usually a liquid. Solvent - A liquid, such as water, kerosene, xylene, or alcohol, that will dissolve a pesticide (or other substance) to form a solution. Suspension - A substance that contains undissolved particles mixed throughout a liquid.