Cannabis Cultivation Pesticide Application Report
Grow Facility Name
License Number
Location Address
Date of Application
Applicator Name
Certification/License No.
Pesticide Details
Pesticide Product Name
EPA Registration No.
Active Ingredient(s)
Amount (Rate & Volume)
Application Method
Target Pest(s)
Lot/Batch No.
Crop Information
Strain(s)/Variety(ies) Treated
Plant Count/Area Treated (sq ft or acres)
Application Details
Application Start Time
Application End Time
Re-entry Interval (hours)
Harvest Interval (days)
Safety & Observations
Protective Equipment Used
Weather Conditions
Additional Notes/Observations
Signature
Applicator Signature
Date