Form LA-17 "Report of Chemical Spray Operations" - California

What Is Form LA-17?

This is a legal form that was released by the California Department of Transportation - 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 April 1, 2001;
  • The latest edition provided by the California Department of Transportation;
  • 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 LA-17 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form LA-17 "Report of Chemical Spray Operations" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
ADA Notice
REPORT OF CHEMICAL SPRAY OPERATIONS
For individuals with sensory disabilities, this document is available in alternate
LA - 17 (REV. 04/2001)
formats.
For information call (916) 654-6410 or TDD (916) 654-3880 or write
Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
REPORT OF CHEMICAL SPRAY OPERATIONS
CONTRACTOR
WEEK ENDING DATE
PROJECT DESCRIPTION
PROEJCT NUMBER
A
B
C
D
CHEMICAL MIXTURE
AND PERCENT
ACTIVE MATERIAL
WATER RATE
APPLICATION PER
SQUARE FOOT OR ACRE
CHECK PROPER BOX
PLANTING SPRAYED
PEST KILLED
DESCRIPTION OF AREA (STA., LOOP, ETC.)
CHEMICAL
USED
A
B
C
D
MON
TUE
WED
THU
FRI
SAT
CONTRACTOR'S REPRESENTATIVE
RESIDENT ENGINEER COMMENTS:
COPY TO: DISTRICT
MAINTENANCE FOR FILE
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
ADA Notice
REPORT OF CHEMICAL SPRAY OPERATIONS
For individuals with sensory disabilities, this document is available in alternate
LA - 17 (REV. 04/2001)
formats.
For information call (916) 654-6410 or TDD (916) 654-3880 or write
Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
REPORT OF CHEMICAL SPRAY OPERATIONS
CONTRACTOR
WEEK ENDING DATE
PROJECT DESCRIPTION
PROEJCT NUMBER
A
B
C
D
CHEMICAL MIXTURE
AND PERCENT
ACTIVE MATERIAL
WATER RATE
APPLICATION PER
SQUARE FOOT OR ACRE
CHECK PROPER BOX
PLANTING SPRAYED
PEST KILLED
DESCRIPTION OF AREA (STA., LOOP, ETC.)
CHEMICAL
USED
A
B
C
D
MON
TUE
WED
THU
FRI
SAT
CONTRACTOR'S REPRESENTATIVE
RESIDENT ENGINEER COMMENTS:
COPY TO: DISTRICT
MAINTENANCE FOR FILE