WW-00915 Reviewed 1998
Dean Herzfeld, Coordinator,
Minnesota Health, Environmental, and Pesticide Safety Programs
|Crop Last Year:||Notes:|
|The first eight items are required to be kept for two years by United States Department of Agriculture for all restricted use pesticide applications under the Food Agriculture Conservation and Trade (FACT) Act of 1990.|
1. NAME AND CERTIFICATION NUMBER OF APPLICATOR:
|MAKE A RECORD OF EACH APPLICATION OF EACH PESTICIDE|
|App. # 1||App. # 2||App # 3||App. # 4||App. # 5|
|2. Field or Site Location/ID|
|3. Date (Mo., Day, Year)|
|4. Size of Area Treated|
|5. Pesticide Used (Brand Name)|
|6. EPA Registration Number|
|7. Total Amount Applied|
|8. Crop/Commodity or Site|
|11. Method of Application|
|12. Stage of Crop Growth|
|13. Purpose of Application|
|14. Stage of Development of Pest|
|15. Soil Conditions|
|17. Time of Day|
|19. Cloud Cover|
This form can be used for recording pesticide applications for weed, insect, or disease control to a particular field or part of a field during a growing season. Farmers may find the record useful for evaluating results and planning future chemical treatments.
The United States Department of Agriculture now requires all applicators of Restricted Use Pesticides (RUP) to record certain information within 14 days of every RUP application. These records are required to be kept for two full years. An "*" is placed next to the USDA required RUP information.
| || |
| || |
READ THE LABEL ON EACH PESTICIDE CONTAINER BEFORE EACH USE. Follow all instructions, heed all precautions, and use protective clothing and equipment as required.
APPLY PESTICIDES ONLY AS DIRECTED. Follow label directions for time, rate, method and crop or site of application.
RINSE PESTICIDE CONTAINERS AT THE TIME OF USE. Follow required triple-rinse or pressure-rinse procedures.
STORE PESTICIDES IN THEIR ORIGINAL, LABELED CONTAINERS. Keep them out of the reach of children and irresponsible people.
RECYCLE RINSED PESTICIDE CONTAINERS. The Minnesota Department of Agriculture is working with local leaders in many counties throughout the state of Minnesota to provide pesticide container recycling programs.
For more information contact your local county extension office or the Minnesota Department of Agriculture.
In accordance with the Americans with Disabilities Act, this material is available in alternative formats upon request. Please contact your University of Minnesota Extension office or the Extension Store at (800) 876-8636.