APPLICATION RECORD KEEPING FORM

1 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.

2 #: 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 INFORMATIONM anufacturer/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 / / / / SPRAYING INFORMATIONAPPLICATION START: APPLICATION END:Time: Air Temperature ( F): Wind Speed (at boom height): Wind Direction (direction from which wind is blowing): Approved Dicamba Rate Per Acre: N/A Total Amount Applied (gallons)N/A Tank-Mix Products (brand names and EPA reg #s, if applicable): Spray System Equipment Cleanout (utilizing product specific triple rinse procedure): (notes) ALWAYS READ AND FOLLOW DIRECTIONS FOR USE ON PESTICIDE LABELING.

3 XtendiMax herbicide with VaporGrip Technology is a restricted use pesticide. It is a violation of Federal and state law to use any pesticide product in a manner inconsistent with its labeling. XtendiMax herbicide with VaporGrip 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. VaporGrip and XtendiMax are trademarks of Monsanto Technology LLC. All other trademarks are the property of their respective owners. 2017 Monsanto Company. All Rights Reserved. 1A4T176362 APPLICATION RECORD KEEPING FORMRECORD KEEPING IS REQUIRED FOR THE APPLICATIONS OF THIS PRODUCT.

4 The applicator must keep the following records for a period of two years Records must be generated as soon as practical but no later than 14 days after APPLICATION A separate RECORD must be kept for each APPLICATION Additional RECORD KEEPING forms can be found at: Use Pestici