"Pesticide Record Keeping Form" - Delaware

This "Pesticide Record Keeping Form" is a document issued by the Delaware Department of Agriculture specifically for Delaware residents with its latest version released on October 2, 1996.

Download the up-to-date fillable PDF by clicking the link below or find it on the forms website of the Delaware Department of Agriculture.

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Download "Pesticide Record Keeping Form" - Delaware

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1
PESTICIDE RECORD KEEPING FORM
APPLICATOR NAME: _________________________
APPLICATOR CERTIFICATION # _______________
APPLICATION ONE
DATE & TIME OF
APPLICATION
FIELD NO:
LOCATION:
ACRES:
Crop
Spot
YES
Pest (s) to be
2
Application
NO
Controlled:
CHEMICAL INFORMATION
PRODUCT NAME (S):
ACTIVE
EPA REG.
RATE PER ACRE
TOTAL AMT.
RESTRICTED
RE-ENTRY
POSTING REQUIRED?
TIME
DATE/TIME
INGREDIENT(S)
NUMBER(S)
(GAL/A)
PRODUCT USED
ENTRY INTERVAL
DATE/TIME
REQUIRED
FIELD POSTED
YES
NO
(HRS)
WEATHER INFORMATION
RELATIVE HUMIDITY
TEMPERATURE
WIND DIRECTION/SPEED
HIGH
MEDIUM
LOW
APPLICATION TWO
DATE & TIME OF
APPLICATION:
FIELD NO:
LOCATION:
ACRES:
Crop
Spot
YES
Pest (s) to be
2
Application
NO
Controlled:
CHEMICAL INFORMATION
PRODUCT NAME (S):
ACTIVE
EPA REG.
RATE PER ACRE
TOTAL AMT.
RESTRICTED
RE-ENTRY
POSTING REQUIRED?
TIME
DATE/TIME
INGREDIENT(S)
NUMBER(S)
(GAL/A)
PRODUCT USED
ENTRY INTERVAL
DATE/TIME
REQUIRED
FIELD POSTED
YES
NO
(HRS)
WEATHER INFORMATION
RELATIVE HUMIDITY
TEMPERATURE
WIND DIRECTION/SPEED
HIGH
MEDIUM
LOW
1
This form provides compliance guidance for the keeping of pesticide application records in accordance with 40 CFR PART 170, Worker Protection Standards; 7 CFR PART 110, Record Keeping Requirements for Certified
Applicators of Federally Restricted Use Pesticides; and SECTION 14, Records, Commercial Applicators, Delaware Pesticide Rules & Regulations. Records for Restricted Use Pesticides must be kept for two (2) years from
date of application.
2
The application of a restricted use pesticide made on the same day in a total area of less than one-tenth (1/10) of an acre.
Document # 65-01-06/96/10/02
1
PESTICIDE RECORD KEEPING FORM
APPLICATOR NAME: _________________________
APPLICATOR CERTIFICATION # _______________
APPLICATION ONE
DATE & TIME OF
APPLICATION
FIELD NO:
LOCATION:
ACRES:
Crop
Spot
YES
Pest (s) to be
2
Application
NO
Controlled:
CHEMICAL INFORMATION
PRODUCT NAME (S):
ACTIVE
EPA REG.
RATE PER ACRE
TOTAL AMT.
RESTRICTED
RE-ENTRY
POSTING REQUIRED?
TIME
DATE/TIME
INGREDIENT(S)
NUMBER(S)
(GAL/A)
PRODUCT USED
ENTRY INTERVAL
DATE/TIME
REQUIRED
FIELD POSTED
YES
NO
(HRS)
WEATHER INFORMATION
RELATIVE HUMIDITY
TEMPERATURE
WIND DIRECTION/SPEED
HIGH
MEDIUM
LOW
APPLICATION TWO
DATE & TIME OF
APPLICATION:
FIELD NO:
LOCATION:
ACRES:
Crop
Spot
YES
Pest (s) to be
2
Application
NO
Controlled:
CHEMICAL INFORMATION
PRODUCT NAME (S):
ACTIVE
EPA REG.
RATE PER ACRE
TOTAL AMT.
RESTRICTED
RE-ENTRY
POSTING REQUIRED?
TIME
DATE/TIME
INGREDIENT(S)
NUMBER(S)
(GAL/A)
PRODUCT USED
ENTRY INTERVAL
DATE/TIME
REQUIRED
FIELD POSTED
YES
NO
(HRS)
WEATHER INFORMATION
RELATIVE HUMIDITY
TEMPERATURE
WIND DIRECTION/SPEED
HIGH
MEDIUM
LOW
1
This form provides compliance guidance for the keeping of pesticide application records in accordance with 40 CFR PART 170, Worker Protection Standards; 7 CFR PART 110, Record Keeping Requirements for Certified
Applicators of Federally Restricted Use Pesticides; and SECTION 14, Records, Commercial Applicators, Delaware Pesticide Rules & Regulations. Records for Restricted Use Pesticides must be kept for two (2) years from
date of application.
2
The application of a restricted use pesticide made on the same day in a total area of less than one-tenth (1/10) of an acre.
Document # 65-01-06/96/10/02
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