Pesticide Application Record Sheet
Date of Application
Field/Location
Crop
Weather Conditions
Applicator Name
Equipment Used
Pesticide Product Name
EPA Reg. No.
Active Ingredient(s)
Rate Applied
Total Amount Used
Target Pest(s)
Area Treated (ac/ha)
Start Time
End Time
Re-entry Interval
Additional Notes/Observations
Supervisor/Manager Signature
Date