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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the 'Person or firm' details, including Name, Address, City/State/Zip, and Phone number. This information identifies who is responsible for the application.
- Fill in the Licensed Applicator’s Name and Business Name (if applicable), along with their License Number and contact details.
- Record the Date of application, Start Time, and Finish Time. Ensure you circle a.m. or p.m. as appropriate.
- Indicate the Target Pests by checking (X) the relevant boxes from the provided list.
- Describe Specific Site(s) treated, such as lawns or trees, and provide details on Concentration or rate of application per unit of measure.
- Document the Size of area treated and Total amount applied using appropriate units like gallons or pounds.
- Specify the Method of application used during treatment.
- List all Pesticide Information for each pesticide used in the tank mix, including Brand Name, Concentration, EPA Registration Number, and Rate Per Unit of Application.
- Complete any optional information such as Wind direction, Wind velocity, Temperature during application, and comments if necessary.
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