Form DPR-ENF-226 "Post-application Summary (Field Fumigation)" - California

What Is Form DPR-ENF-226?

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 December 1, 2010;
  • 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-ENF-226 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-ENF-226 "Post-application Summary (Field Fumigation)" - California

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STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
POST-APPLICATION SUMMARY
ENFORCEMENT BRANCH
ATTACHMENT # ______
(FIELD FUMIGATION)
-- Attach to Fumigant Management Plan --
PAGE ______ OF ______
DPR-ENF-226 (NEW 12-10) PAGE 1
A. Application
DATE OF APPLICATION
PERMIT NUMBER
SITE IDENTIFICATION NUMBER
FIELD LOCATION / BLOCK NUMBER
PROPOSED TREATED ACRES
TOTAL TREATED ACRES / RATE
SUMMARY OF WEATHER CONDITIONS ON THE DAY OF THE APPLICATION AND DURING THE 48-HOUR PERIOD FOLLOWING THE APPLICATION
B. Tarp Perforation / Removal - Tarp Used
YES
NO
COMPLETE THE FOLLOWING IF DIFFERENT FROM THE FUMIGANT MANAGEMENT PLAN:
PERSON RESPONSIBLE FOR CUTTING TARP
TELEPHONE NUMBER (Include Area Code) TARP CUTTING METHOD
DATE OF TARP CUTTING
Tarp Repair
YES
NO
LOCATION AND SIZE OF TARP DAMAGE
DATE AND TIME OF TARP REPAIR(S)
DESCRIPTION OF ANY TARP / TARP SEAL / TARP EQUIPMENT FAILURE
TARP REMOVAL METHOD
TARP REMOVED BY
DATE OF TARP REMOVAL
C. Elevated Air Concentrations Measured
YES
NO
LOCATION OF ELEVATED AIR CONCENTRATION LEVELS
HANDLER TASK / ACTIVITY
DATE AND TIME
SENSORY IRRITATION EXPERIENCED
YES
NO
LOCATION WHERE IRRITATION EXPERIENCED
ACTION TAKEN
HANDLER TASK / ACTIVITY
DATE AND TIME
DIRECT-READ INSTRUMENT
YES (Type used)__________________________________________
NO
HANDLER LOCATION
AIR CONCENTRATION
D. Posting
DATE OF TREATED AREA SIGN REMOVAL
SIGNS REMOVED BY
E. Deviations from the Fumigation Management Plan
YES
NO
PROVIDE DESCRIPTION OF ANY DEVIATIONS
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
POST-APPLICATION SUMMARY
ENFORCEMENT BRANCH
ATTACHMENT # ______
(FIELD FUMIGATION)
-- Attach to Fumigant Management Plan --
PAGE ______ OF ______
DPR-ENF-226 (NEW 12-10) PAGE 1
A. Application
DATE OF APPLICATION
PERMIT NUMBER
SITE IDENTIFICATION NUMBER
FIELD LOCATION / BLOCK NUMBER
PROPOSED TREATED ACRES
TOTAL TREATED ACRES / RATE
SUMMARY OF WEATHER CONDITIONS ON THE DAY OF THE APPLICATION AND DURING THE 48-HOUR PERIOD FOLLOWING THE APPLICATION
B. Tarp Perforation / Removal - Tarp Used
YES
NO
COMPLETE THE FOLLOWING IF DIFFERENT FROM THE FUMIGANT MANAGEMENT PLAN:
PERSON RESPONSIBLE FOR CUTTING TARP
TELEPHONE NUMBER (Include Area Code) TARP CUTTING METHOD
DATE OF TARP CUTTING
Tarp Repair
YES
NO
LOCATION AND SIZE OF TARP DAMAGE
DATE AND TIME OF TARP REPAIR(S)
DESCRIPTION OF ANY TARP / TARP SEAL / TARP EQUIPMENT FAILURE
TARP REMOVAL METHOD
TARP REMOVED BY
DATE OF TARP REMOVAL
C. Elevated Air Concentrations Measured
YES
NO
LOCATION OF ELEVATED AIR CONCENTRATION LEVELS
HANDLER TASK / ACTIVITY
DATE AND TIME
SENSORY IRRITATION EXPERIENCED
YES
NO
LOCATION WHERE IRRITATION EXPERIENCED
ACTION TAKEN
HANDLER TASK / ACTIVITY
DATE AND TIME
DIRECT-READ INSTRUMENT
YES (Type used)__________________________________________
NO
HANDLER LOCATION
AIR CONCENTRATION
D. Posting
DATE OF TREATED AREA SIGN REMOVAL
SIGNS REMOVED BY
E. Deviations from the Fumigation Management Plan
YES
NO
PROVIDE DESCRIPTION OF ANY DEVIATIONS
POST-APPLICATION SUMMARY
(FIELD FUMIGATION)
ATTACHMENT # ______
-- Attach to Fumigant Management Plan --
PAGE ______ OF ______
DPR-ENF-226 (NEW 12-10) PAGE 2
F. Incidents
YES
NO
DESCRIPTION OF INCIDENTS, EQUIPMENT FAILURE, OR OTHER EMERGENCY AND RESPONSE
G. Complaints - Complaints Received
YES
NO
TYPE OF PERSON FILING COMPLAINT (e.g., On-site handler, bystander)
NAME (If bystander)
BYSTANDER'S ADDRESS (Number and Street, City, State, ZIP Code)
BYSTANDER'S TELEPHONE NUMBER (Include Area Code)
DESCRIPTION OF CONTROL MEASURES OR EMERGENCY PROCEDURES TAKEN (Continued)
H. Attachments (List ALL Attachments)
POST-APPLICATION WATER TREATMENTS
MONITORING DURING APPLICATION
MONITORING POST-APPLICATION
AIR MONITORING
OTHER
I verify that the information provided in this Fumigant Management Plan and its attachments accurately reflect the actual conditions associated
with this application. I certify that I will maintain this record and make it available for inspection for two years from the date of the application.
______________________________________________________________________________
___________________________________________
SIGNATURE OF CERTIFIED APPLICATOR SUPERVISING APPLICATION
DATE
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