APPLICATION RECORD KEEPING FORM

Certified Applicator Name: State Certification # of Applicator: Applicator Name (if different from Certified Applicator): REQUIRED DICAMBA APPLICATOR TRAININGA pplicator 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 INFORMATIONR etain 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.

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.

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  Form, Applications, Record, Keeping, Application record keeping form

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