"Pesticide Application Record for Government, and Restricted Use Pesticides" - Nevada

Pesticide Application Record for Government, and Restricted Use Pesticides is a legal document that was released by the Nevada Department of Agriculture - a government authority operating within Nevada.

Form Details:

  • Released on October 1, 2019;
  • The latest edition currently provided by the Nevada Department of Agriculture;
  • 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 fillable version of the form by clicking the link below or browse more documents and templates provided by the Nevada Department of Agriculture.

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st
405 S. 21
St
2300 E St. Louis Ave.
Sparks, NV 89431
Las Vegas NV 89104
MONTH/YEAR:
• 
PESTICIDE APPLICATION RECORD FOR: Agency Name
GOVERNMENT LICENSE NO.:
# of Units or Area
Date
Property Address Treated
Brand Name or Generic Name
EPA Registration Number
Total Amount of diluted material
Item , Site or Commodity Treated
Full Name of the Applicator •
of the Pesticide
and concentration Applied
Treated or Vol.
Full Name of the Applicator or
• ;
or
Amount of Undiluted Product
Applicator Supervising the
• 
• 
• 
Fumigated
• 
(Rate/Acre)
Application 
• 
1
2
3
4
5
6
7
8
Wind Velocity & Wind Direction
Start and Finish Time of Treatment
Purpose for which the site was
Temperature
treated
NOTE: • & , indicate which columns
1
Start
Finish
Finish
must be reported for each type of
Start
1
Start
1
2
Finish
1
2
• •
application record according to various
required state, or federal reporting laws.
1
= Government applicators
 = Application of Restricted Use Pesticides
2
(RUP's).
1
= required if treatment is conducted in categories
3
of invertebrate/vertebrate/weeds aquatic weeds terrestrial.
and plant diseases.
4
= required if treatment is conducted in fumiagtion
2
categories.
5
* 2 Years of Records required for each property
treated = • 
6
7
Government record (Rev. 10-19)
8
st
405 S. 21
St
2300 E St. Louis Ave.
Sparks, NV 89431
Las Vegas NV 89104
MONTH/YEAR:
• 
PESTICIDE APPLICATION RECORD FOR: Agency Name
GOVERNMENT LICENSE NO.:
# of Units or Area
Date
Property Address Treated
Brand Name or Generic Name
EPA Registration Number
Total Amount of diluted material
Item , Site or Commodity Treated
Full Name of the Applicator •
of the Pesticide
and concentration Applied
Treated or Vol.
Full Name of the Applicator or
• ;
or
Amount of Undiluted Product
Applicator Supervising the
• 
• 
• 
Fumigated
• 
(Rate/Acre)
Application 
• 
1
2
3
4
5
6
7
8
Wind Velocity & Wind Direction
Start and Finish Time of Treatment
Purpose for which the site was
Temperature
treated
NOTE: • & , indicate which columns
1
Start
Finish
Finish
must be reported for each type of
Start
1
Start
1
2
Finish
1
2
• •
application record according to various
required state, or federal reporting laws.
1
= Government applicators
 = Application of Restricted Use Pesticides
2
(RUP's).
1
= required if treatment is conducted in categories
3
of invertebrate/vertebrate/weeds aquatic weeds terrestrial.
and plant diseases.
4
= required if treatment is conducted in fumiagtion
2
categories.
5
* 2 Years of Records required for each property
treated = • 
6
7
Government record (Rev. 10-19)
8
st
405 S. 21
St
NEVADA DEPARTMENT OF AGRICULTURE
2300 E. St. Louis Ave
Sparks, NV 89431
Las Vegas NV 89104
PESTICIDE USE REPORT
PESTICIDE APPLICATION RECORD FOR GOVERNMENT (•), AND RESTRICTED USE PESTICIDES()
MONTH/YEAR:
• 
PESTICIDE APPLICATION RECORD FOR: Agency Name
GOVERNMENT LICENSE NO. :
• 
Date
Property Address Treated
Brand Name or Generic Name
EPA Registration Number
Total Amount of diluted material
# of Units or Area
Item , Site or Commodity Treated
Full Name of the Applicator •
of the Pesticide
and concentration Applied
• ;
Treated or Vol.
Full Name of the Applicator or
or
Amount of Undiluted Product
Fumigated
Applicator Supervising the
• 
• 
• 
(Rate/Acre) 
Application 
• 
• 
9
10
11
12
13
14
15
16
Temperature
Wind Velocity & Wind Direction
Purpose for which the site was
Start & Finish Times of Treatment
FOR OFFICIAL USE
treated
ONLY
Start
Finish
1
Start
1
2
Finish
1
Start
Finish
1
2
• •
9
10
11
12
13
14
15
16
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