L
D
A
& F
*4106*
OUISIANA
EPARTMENT OF
GRICULTURE
ORESTRY
M
S
, C
DVM
IKE
TRAIN
OMMISSIONER
Agricultural & Environmental Sciences, 5825 Florida Blvd, Suite 3003, Baton Rouge, LA 70806, (225) 925-3796, FAX (225) 925-3760
COMMERCIAL PESTICIDE APPLICATOR RECORD KEEPING FORM
OWNER / OPERATOR (FIRM):
LICENSE NUMBER:
CERTIFIED APPLICATOR:
ADDRESS:
LDAF CARD NUMBER:
CUSTOMER
PESTICIDE APPLIED
APPLICATOR
1
NAME
ADDRESS
BRAND NAME
EPA REG.
RUP
CROP OR
LOCATION
SIZE OF
RATE
TOTAL AMT.
NAME
DATE
LDAF CARD
2
4
OF PRODUCT
NUMBER
TYPE OF
OF APP.
AREA
OF
APPLIED
OF APP.
NUMBER
3
APP.
TREATED
APP.
(IF APPLIC.)
1. Check if Pesticide is a Restricted Use Pesticide.
2. Field number or other reference as to the location of the application.
3. Acres, square feet, minutes of spraying, etc.
4. Refers to total amount of pesticide product (concentrate) used.
L
D
A
& F
*4106*
OUISIANA
EPARTMENT OF
GRICULTURE
ORESTRY
M
S
, C
DVM
IKE
TRAIN
OMMISSIONER
Agricultural & Environmental Sciences, 5825 Florida Blvd, Suite 3003, Baton Rouge, LA 70806, (225) 925-3796, FAX (225) 925-3760
COMMERCIAL PESTICIDE APPLICATOR RECORD KEEPING FORM
OWNER / OPERATOR (FIRM):
LICENSE NUMBER:
CERTIFIED APPLICATOR:
ADDRESS:
LDAF CARD NUMBER:
CUSTOMER
PESTICIDE APPLIED
APPLICATOR
1
NAME
ADDRESS
BRAND NAME
EPA REG.
RUP
CROP OR
LOCATION
SIZE OF
RATE
TOTAL AMT.
NAME
DATE
LDAF CARD
2
4
OF PRODUCT
NUMBER
TYPE OF
OF APP.
AREA
OF
APPLIED
OF APP.
NUMBER
3
APP.
TREATED
APP.
(IF APPLIC.)
1. Check if Pesticide is a Restricted Use Pesticide.
2. Field number or other reference as to the location of the application.
3. Acres, square feet, minutes of spraying, etc.
4. Refers to total amount of pesticide product (concentrate) used.
