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U.S. EPA RESTRICTED USE PESTICIDE Application Record ... · U.S. EPA RESTRICTED USE PESTICIDE...

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U.S. EPA RESTRICTED USE PESTICIDE Application Record Keeping Requirements Form Applicators must keep the following records for a period of two years (unless your state requires longer); records must be generated within 14 days of application (unless your state requires shorter) and a record must be kept for each application to each field. Records must be made available to State Pesticide Control Official(s), USDA, and EPA upon request. The following information must be recorded and kept as required by the Federal Pesticide Record Keeping Program, 7 CFR Part 110: Full Name of Certified Applicator State Certification # for the Applicator Product Name Date of Application Crop Location of the Application (field name or GPS coordinates) How was the product applied? Preemergence Postemergence If post, how many days after planting? Spray Nozzle Type Spray Pressure (List all pesticides, adjuvants, and other products - EPA Reg # only required for pesticides) Product 3 EPA Reg # Product 3 EPA Reg # Engenia Rate/A (fl oz) Acres Treated Total Gallons Engenia Applied = Start Time End Time Air Temperature º F Air Temperature º F (at boom height) (at boom height) Wind Speed mph Wind Speed mph (at boom height) (at boom height) Wind Direction Wind Direction Date Method of cleanout Before Application Application Tank Mixes Spraying Conditions Cleanout I have purchase receipts (check for yes) Registry -AND- Date neighboring fields were surveyed for susceptible crops 1 Date of dicamba or auxin-specific training completion 2 Provider Applicator Name (if different from Certified Applicator) Before Application After Application 3 Drop-down list includes approved BASF tank mix products and associated EPA Reg # only. See Engeniatankmix.com for complete list. EPA Reg # I have a copy of the product label and state special local needs labels (check for yes) Target pest (s)(complete if required by your state) Name and date of sensitive crop registry consultation Engenia herbicide is a U.S. EPA restricted use pesticide. This form meets the RUP record keeping requirements for Engenia herbicide per the U.S. EPA label Reg No 7969-345, at “RESTRICTED USE PESTICIDE APPLICATION RECORD KEEPING AND TRAINING REQUIREMENTS.” Please check with your state pesticide regulatory authority as additional requirements may be imposed by your state. ALWAYS READ AND FOLLOW LABEL DIRECTIONS. Engenia ® is a registered trademark of BASF Corporation. © 2018 BASF Corporation. All Rights Reserved. 1 Records must include the date the applicator consulted the specialty crop registry or surveyed neighboring fields, and the name of the specialty crop registry the applicator consulted. 2 All applicators must complete dicamba or auxin-specific training before application via: 1) state-required training in state of application, 2) a registrant of a dicamba product approved for in- crop use with dicamba-tolerant crops, or 3) a state or state-authorized provider. (e.g., required for Commercial applicators in Iowa)
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Page 1: U.S. EPA RESTRICTED USE PESTICIDE Application Record ... · U.S. EPA RESTRICTED USE PESTICIDE Application Record Keeping Requirements Form . Applicators must keep the following records

U.S. EPA RESTRICTED USE PESTICIDE Application Record Keeping Requirements Form

Applicators must keep the following records for a period of two years (unless your state requires longer); records must be generated within 14 days of application (unless your state requires shorter) and a record must be kept for each application to each field. Records must be made available to State Pesticide Control Official(s), USDA, and EPA upon request. The following information must be recorded and kept as required by the Federal Pesticide Record Keeping Program, 7 CFR Part 110:

Full Name of Certified Applicator State Certification # for the Applicator

Product Name

Date of Application Crop Location of the Application (field name or GPS coordinates)

How was the product applied? Preemergence Postemergence If post, how many days after planting?

Spray Nozzle Type Spray Pressure

(List all pesticides, adjuvants, and other products - EPA Reg # only required for pesticides) Product3 EPA Reg # Product3 EPA Reg #

Engenia Rate/A (fl oz) Acres Treated Total Gallons Engenia Applied =

Start Time End Time

Air Temperature º F Air Temperature º F (at boom height) (at boom height) Wind Speed mph Wind Speed mph (at boom height) (at boom height)

Wind Direction Wind Direction

Date Method of cleanout

Bef

ore

App

licat

ion

App

licat

ion

Tank

Mix

es

Spra

ying

Con

ditio

ns

Cle

anou

t

I have purchase receipts (check for yes)

Registry -AND-

Date neighboring fields were surveyed for susceptible crops1

Date of dicamba or auxin-specific training completion 2 Provider

Applicator Name (if different from Certified Applicator)

Before Application

After Application

3 Drop-down list includes approved BASF tank mix products and associated EPA Reg # only. See Engeniatankmix.com for complete list.

EPA Reg #

I have a copy of the product label and state special local needs labels (check for yes)

Target pest (s)(complete if required by your state)

Name and date of sensitive crop registry consultation

Engenia herbicide is a U.S. EPA restricted use pesticide. This form meets the RUP record keeping requirements for Engenia herbicide per the U.S. EPA label Reg No 7969-345, at “RESTRICTED USE

PESTICIDE APPLICATION RECORD KEEPING AND TRAINING REQUIREMENTS.” Please check with your state pesticide regulatory authority as additional requirements may be imposed by your state.

ALWAYS READ AND FOLLOW LABEL DIRECTIONS. Engenia® is a registered trademark of BASF Corporation. © 2018 BASF Corporation. All Rights Reserved.

1 Records must include the date the applicator consulted the specialty crop registry or surveyed neighboring fields, and the name of the specialty crop registry the applicator consulted. 2 All applicators must complete dicamba or auxin-specific training before application via: 1) state-required training in state of application, 2) a registrant of a dicamba product approved for in-crop use with dicamba-tolerant crops, or 3) a state or state-authorized provider.

(e.g., required for Commercial applicators in Iowa)

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