APPLICATION RECORD KEEPING FORM

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Certified Applicator Name: State Certification # of Applicator: Applicator Name (if different from Certified Applicator): REQUIRED DICAMBA APPLICATOR TRAININGApplicator Name (if different from Certified Applicator): Date Completed (MM/DD/YY): / / Provider (be sure to retain proof of completion): SUSCEPTIBLE CROP AWARENESSName and Date of the Sensitive Crop Registry Consulted: / / ORDate Neighboring Fields Were Surveyed for Susceptible Crops: / / (findings)PRE- APPLICATION INFORMATIONRetain receipt of each purchase for each APPLICATION . Retain copy of all product labels, including state labels where applicable. (Current label can be found at: )Approved Dicamba Product Name & EPA Reg. #: To Be Applied To:Corn Cotton Soybeans Other Location of APPLICATION : Buffer Distance Calculation: Size of Treated Area: Check to Confirm Spray System Equipment Is Cleaned Prior to Using: (notes) NOZZLE INFORMATIONManufacturer/Brand: Type: Orifice Size: Operating Pressure: APPLICATION TIMINGDate of APPLICATION :(check only one) Burndown Pre-Plant At Planting Pre-Emergence Postemergence / / / / / / / / / / Date Crop Planted:N/AN/AN/A / / / /

Technology is not registered in all states and may be subject to use restrictions in some states. Check with your local Monsanto dealer or representative for the product registration status in your state.