Form DPR-PML-183 "Production Agriculture Monthly Pesticide Use Report: Multiple Site/Commodity" - California

What Is Form DPR-PML-183?

This is a legal form that was released by the California Department of Pesticide Regulation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2015;
  • The latest edition provided by the California Department of Pesticide Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DPR-PML-183 by clicking the link below or browse more documents and templates provided by the California Department of Pesticide Regulation.

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Download Form DPR-PML-183 "Production Agriculture Monthly Pesticide Use Report: Multiple Site/Commodity" - California

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STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
PEST MANAGEMENT AND LICESNING BRANCH
PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT: MULTIPLE SITE/COMMODITY
DPR-PML-183 (REV. 08/15) Page 1 of 2
SEE INSTRUCTIONS ON THE REVERSE OF THIS FORM
3. COUNTY NO.
1. MONTH
2. YEAR
4. SECTION
5. TOWNSHIP
6. RANGE
7. BASE & MERIDIAN
8. OPERATOR ID / PERMIT NO.
9. OPERATOR (GROWER)
10. ADDRESS
11. CITY
12. ZIP CODE
N
E
S
W
S
M
H
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
SITE
DATE / TIME
COMMODITY / SITE TREATED
PRE-PLANT
TOTAL
TOTAL
APPLICATION METHOD
EPA / CALIF. REG. NO. FROM LABEL
TOTAL
RATE
DILUTION
DAYS
MANUFACTURER / NAME OF PRODUCT
IDENTIFICATION
APPLICATION
PLANTED
TREATED
(CHECK ONE)
PRODUCT USED
PER ACRE
REENTRY
(IF APPLICABLE)
NUMBER
ACRES
ACRES
(CHECK ONE UNIT OF
MEASURE)
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
FOR AGENCY USE ONLY
REPORT PREPARED BY
REVIEWED BY
DATE
Distribution: (1) CAC; (2,3) Applicator
SUBMIT TO AGRICULTURAL COMMISSIONER WITHIN 10 DAYS OF MONTH FOLLOWING APPLICATION
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
PEST MANAGEMENT AND LICESNING BRANCH
PRODUCTION AGRICULTURE MONTHLY PESTICIDE USE REPORT: MULTIPLE SITE/COMMODITY
DPR-PML-183 (REV. 08/15) Page 1 of 2
SEE INSTRUCTIONS ON THE REVERSE OF THIS FORM
3. COUNTY NO.
1. MONTH
2. YEAR
4. SECTION
5. TOWNSHIP
6. RANGE
7. BASE & MERIDIAN
8. OPERATOR ID / PERMIT NO.
9. OPERATOR (GROWER)
10. ADDRESS
11. CITY
12. ZIP CODE
N
E
S
W
S
M
H
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
SITE
DATE / TIME
COMMODITY / SITE TREATED
PRE-PLANT
TOTAL
TOTAL
APPLICATION METHOD
EPA / CALIF. REG. NO. FROM LABEL
TOTAL
RATE
DILUTION
DAYS
MANUFACTURER / NAME OF PRODUCT
IDENTIFICATION
APPLICATION
PLANTED
TREATED
(CHECK ONE)
PRODUCT USED
PER ACRE
REENTRY
(IF APPLICABLE)
NUMBER
ACRES
ACRES
(CHECK ONE UNIT OF
MEASURE)
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
GROUND
AIR
FUME
OTHER
LB
OZ
PT
QT
GA
FOR AGENCY USE ONLY
REPORT PREPARED BY
REVIEWED BY
DATE
Distribution: (1) CAC; (2,3) Applicator
SUBMIT TO AGRICULTURAL COMMISSIONER WITHIN 10 DAYS OF MONTH FOLLOWING APPLICATION
USE REPORT COMPLETION INSTRUCTIONS
FOR THE MULTIPLE SITE/COMMODITY REPORT
(Page 2 of 2)
These instructions will assist you in completing this form. The completed forms must be submitted to the
agricultural commissioner in the county where the pest control work was performed by the 10th day of the
month following the month of application.
1 - 2. Enter the month and year of the pesticide applications.
3. Indicate the county number. This is available from the local county agricultural commissioner.
4 - 6. Indicate the section, township, and range designation for each site that is treated. These
designations must be the same as those on a restricted material permit. Otherwise, a coordinate
map showing the designations must be used to determine the appropriate information. The
respective compass points, e.g., "N" or "S," should be checked as well.
7. There are only three base and meridians in California. One of the following code letters must be
used to complete the section: H-Humboldt, M-Mount Diablo, S-San Bernardino.
8. Enter the Operator Identification Number/Restricted Material Permit Number assigned by the
county agricultural commissioner.
9 - 12. Identify the property operator (grower) and complete the address information.
13. Each commodity/site is assigned a unique identification number of eight digits. Enter this
number exactly as it was issued by the county agricultural commissioner.
14. For each pesticide application, indicate the date and hour it was completed. Use a 24-hour clock
or military time, e.g., 7:00 a.m. as 0700, 4:00 p.m. as 1600.
15. Enter the commodity/site by common name. Identify the specific type of commoddity, e.g., head
lettuce, loose-leaf lettuce, table grapes, wine grapes. do not use general terms such as "herbs,"
"citrus," or "cole crops."
16. Check this box if the pesticide treatment is a pre-plant application.
17. Indicate the total planted acres or units at the treatment site. For pre-plant applications, enter the
total acreage or units to be planted.
18. For each application, report the total acreage treated. For band applications or strip spraying,
report the total acreage at the site. For spot spraying or partial applications, e.g., border
treatments, indicate only the acreage that was actually treated.
19. Check the method of application that represents each application. If checking "FUME" (fumigation),
include the four-digit, numeric field fumigation method code.
20. Each pesticide is assigned an "EPA Reg. No." or "Calif. Reg. No." that appears on the label.
Identify the entire number including the alpha code, e.g., "AA," "ZA," or "ZB," for each pesticide
that is used. Do not use the "EPA Est. No." Spreader stickers, adjuvants, and drift control agents
are registered as pesticides in California and must be reported. Do not report nutrients, fertilizers,
buffers, etc., that have no EPA registration number.
21. Identify the total amount of formulated (packaged) product that was used for each application.
Do not report the total mixture after dilution. Check only one unit of measure. If necessary,
decimals and fractions may be used.
22 - 23. Indicate rate at which the pesticide was applied as required by the label or regulation. (Optional)
24. Enter the safety reentry interval as required by the pesticide label or regulation. (Optional)
25. List the name of pesticide manufacturer and product as identified on the label. Include the
brand or trade name and type of formulation if it is indicated on the label, e.g., Pestkill 30W,
NoGro 6E, or Mildex SP.
If you have any questions or need additional assistance in completing this form, please contact your local
county agricultural commissioner.
Page of 2