"Pesticide General Permit Annual Report Form" - South Dakota

Pesticide General Permit Annual Report Form is a legal document that was released by the South Dakota Department of Environment & Natural Resources - a government authority operating within South Dakota.

Form Details:

  • The latest edition currently provided by the South Dakota Department of Environment & Natural Resources;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the South Dakota Department of Environment & Natural Resources.

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Pesticide General Permit Annual Report
1.
The permittee's name:_______________________________________________________
2.
South Dakota Certified Pesticide Applicator number (if applicable): __________________
3.
The total surface water treatment area in acres or linear miles as appropriate for each
pesticide use category and the target pests:
a. Mosquito and Other Flying Insect Pest Control
Acres: _____________________________________________________________
Target Pests: ________________________________________________________
___________________________________________________________________
b. Weed and Algae Control
Acres of surface water: ________________________________________________
Linear miles at waters edge: ____________________________________________
Target Pests: ________________________________________________________
___________________________________________________________________
c. Aerial Pest Control
Acres of surface water: ________________________________________________
Target Pests: ________________________________________________________
___________________________________________________________________
d. Ditch and Stream Bank Pest Control
Acres of surface water: ________________________________________________
Linear miles at waters edge: ____________________________________________
Target Pests: ________________________________________________________
___________________________________________________________________
4.
Was pesticide applied because of a declared pest emergency? (Yes or No): _____________
If yes, then list the dates and times this occurred, the target pest, and what
government entity declared the pest emergency.
Date
Time
Pest
Governing body declaring emergency
Pesticide General Permit Annual Report
1.
The permittee's name:_______________________________________________________
2.
South Dakota Certified Pesticide Applicator number (if applicable): __________________
3.
The total surface water treatment area in acres or linear miles as appropriate for each
pesticide use category and the target pests:
a. Mosquito and Other Flying Insect Pest Control
Acres: _____________________________________________________________
Target Pests: ________________________________________________________
___________________________________________________________________
b. Weed and Algae Control
Acres of surface water: ________________________________________________
Linear miles at waters edge: ____________________________________________
Target Pests: ________________________________________________________
___________________________________________________________________
c. Aerial Pest Control
Acres of surface water: ________________________________________________
Target Pests: ________________________________________________________
___________________________________________________________________
d. Ditch and Stream Bank Pest Control
Acres of surface water: ________________________________________________
Linear miles at waters edge: ____________________________________________
Target Pests: ________________________________________________________
___________________________________________________________________
4.
Was pesticide applied because of a declared pest emergency? (Yes or No): _____________
If yes, then list the dates and times this occurred, the target pest, and what
government entity declared the pest emergency.
Date
Time
Pest
Governing body declaring emergency