Pesticide Application Records This template may be used for records required in LM4.13. Date: / / Location: ______________ Target Pest: _____________________ Threshold level reached: ❏ Yes No Pesticide product and Active diluent applied: ingredient Application Method: Concentration ______________________ and amount: ______________________ Applicator: Application Yes ______________________ effective: No Date: / / Location: ______________ Target Pest: _____________________ ❏ Threshold level reached: Yes No Pesticide product and Active diluent applied: ingredient Application Method: Concentration ______________________ and amount: ______________________ Applicator: Application Yes ______________________ effective: No Date: / / Location: ______________ Target Pest: _____________________ ❏ Threshold level reached: Yes No Pesticide product and Active diluent applied: ingredient Application Method: Concentration ______________________ and amount: ______________________ Applicator: Application Yes ______________________ effective: No
Pesticide Application Records This template may be used for records required in LM4.13. Date: / / Location: ______________ Target Pest: _____________________ Threshold level reached: Yes ❏ No Pesticide product and diluent applied: Active ingredient Application Method: ______________________ Concentration and amount: ______________________ Applicator: ______________________ Application effective: Yes No Date: / / Location: ______________ Target Pest: _____________________ Threshold level reached: Yes ❏ No Pesticide product and diluent applied: Active ingredient Application Method: ______________________ Concentration and amount: ______________________ Applicator: ______________________ Application effective: Yes No Date: / / Location: ______________ Target Pest: _____________________ Threshold level reached: Yes ❏ No Pesticide product and diluent applied: Active ingredient Application Method: ______________________ Concentration and amount: ______________________ Applicator: ______________________ Application effective: Yes No
Pesticide-Application-Record.docx