Listed on your Reason for For Use For IDALS Use Name of Product Manufacturer Name/Address/Phone # Active and Use Inspector (circle all that Only Allowed list? (as listed on label) (Do not list distributor or sales person) (ex: fertility, pest Use Only apply) control, etc.) (attached) Allowed Used Used Restricted ________ Y N On site Plan to use Prohibited Discontinued Want reviewed Not reviewed Allowed Used Used Restricted ________ Y N On site Plan to use Prohibited Discontinued Want reviewed Not reviewed Allowed Used Used Restricted ________ Y N On site Plan to use Prohibited Discontinued Want reviewed Not reviewed Allowed Used Used Restricted ________ Y N On site Plan to use Prohibited Discontinued Want reviewed Not reviewed Allowed Used Used Restricted ________ Y N On site Plan to use Prohibited Discontinued Want reviewed Not reviewed Allowed Used Used Restricted ________ Y N On site Plan to use Prohibited Discontinued Want reviewed Not reviewed Allowed Used Used Restricted ________ Y N On site Plan to use Prohibited Discontinued Want reviewed Not reviewed Allowed Used Used Restricted ________ Y N On site Plan to use Prohibited Discontinued Want reviewed Not reviewed Allowed Used Used Restricted ________ Y N On site Plan to use Prohibited Discontinued Want reviewed Not reviewed Allowed Used Used Restricted ________ Y N On site Plan to use Prohibited Discontinued Want reviewed Not reviewed
For Inspector Use Only Name of Product (as listed on label) Use (circle all that apply) Manufacturer Name/Address/Phone # (Do not list distributor or sales person) Reason for Use (ex: fertility, pest control, etc.) Listed on your Active and Allowed list? (attached) For IDALS Use Only Used On site Discontinued Used Plan to use Want reviewed Y N Allowed Restricted ________ Prohibited Not reviewed Used On site Discontinued Used Plan to use Want reviewed Y N Allowed Restricted ________ Prohibited Not reviewed Used On site Discontinued Used Plan to use Want reviewed Y N Allowed Restricted ________ Prohibited Not reviewed Used On site Discontinued Used Plan to use Want reviewed Y N Allowed Restricted ________ Prohibited Not reviewed Used On site Discontinued Used Plan to use Want reviewed Y N Allowed Restricted ________ Prohibited Not reviewed Used On site Discontinued Used Plan to use Want reviewed Y N Allowed Restricted ________ Prohibited Not reviewed Used On site Discontinued Used Plan to use Want reviewed Y N Allowed Restricted ________ Prohibited Not reviewed Used On site Discontinued Used Plan to use Want reviewed Y N Allowed Restricted ________ Prohibited Not reviewed Used On site Discontinued Used Plan to use Want reviewed Y N Allowed Restricted ________ Prohibited Not reviewed Used On site Discontinued Used Plan to use Want reviewed Y N Allowed Restricted ________ Prohibited Not reviewed
10%20Crops%20Materials%20Used.docx