Transcription of APPLICATION RECORD KEEPING FORM
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Example: bachelor of science
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.
It is a violation of Federal and state law to use any pesticide product in a manner inconsistent with its labeling. XtendiMax ®
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