Form FDACS-13652 "Mosquito Control Monthly Activity Report" - Florida

Form FDACS-13652 or the "Mosquito Control Monthly Activity Report" is a form issued by the Florida Department of Agriculture and Consumer Services.

The form was last revised in July 1, 2013 and is available for digital filing. Download an up-to-date Form FDACS-13652 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

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Download Form FDACS-13652 "Mosquito Control Monthly Activity Report" - Florida

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Florida Department of Agriculture and Consumer Services
Submit to:
Division of Agricultural Environmental Services
Mosquito Control Program
3125 Conner Blvd, Suite E
Tallahassee, FL 32399-1650
MOSQUITO CONTROL MONTHLY ACTIVITY REPORT
Rule 5E-13.022, F. A. C.
ADAM H. PUTNAM 
Telephone: (850) 617-7911; FAX: (850) 617-7939
COMMISSIONER 
COUNTY OR DISTRICT
MONTH
YEAR
CHEMICAL ADULTICIDE
U
T
G
A
ACRES
ACRES
 Show % of active ingredient (a.i.), EPA#
L
H
R
I
TL OUTPUT
TL OUTPUT
MIX RATIO FOR
TREATED
TREATED
 Delete rows of chemicals not used
V
R
N
R
FORMULATION
MONTHLY
YEARLY gal/lb
MONTHLY
YEARLY
M
D
 Check the appropriate method of treatment
CHEMICAL LARVICIDE
G
A
ACRES
ACRES
 Show % of active ingredient (a.i.), EPA#
R
I
MIX RATIO FOR
TL OUTPUT
TL OUTPUT
TREATED
TREATED
 Delete rows of chemicals not used
N
R
FORMULATION
MONTHLY
YEARLY gal/lb
MONTHLY
YEARLY
D
 Check the appropriate method of treatment
FDACS-13652 Rev. 07/13
Florida Department of Agriculture and Consumer Services
Submit to:
Division of Agricultural Environmental Services
Mosquito Control Program
3125 Conner Blvd, Suite E
Tallahassee, FL 32399-1650
MOSQUITO CONTROL MONTHLY ACTIVITY REPORT
Rule 5E-13.022, F. A. C.
ADAM H. PUTNAM 
Telephone: (850) 617-7911; FAX: (850) 617-7939
COMMISSIONER 
COUNTY OR DISTRICT
MONTH
YEAR
CHEMICAL ADULTICIDE
U
T
G
A
ACRES
ACRES
 Show % of active ingredient (a.i.), EPA#
L
H
R
I
TL OUTPUT
TL OUTPUT
MIX RATIO FOR
TREATED
TREATED
 Delete rows of chemicals not used
V
R
N
R
FORMULATION
MONTHLY
YEARLY gal/lb
MONTHLY
YEARLY
M
D
 Check the appropriate method of treatment
CHEMICAL LARVICIDE
G
A
ACRES
ACRES
 Show % of active ingredient (a.i.), EPA#
R
I
MIX RATIO FOR
TL OUTPUT
TL OUTPUT
TREATED
TREATED
 Delete rows of chemicals not used
N
R
FORMULATION
MONTHLY
YEARLY gal/lb
MONTHLY
YEARLY
D
 Check the appropriate method of treatment
FDACS-13652 Rev. 07/13
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