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Get and Sign Pesticide Annual Report Form 44 15 26a Form 2001-2022
NAME
QUANTITY
USED
UNITS
Col. 5
DATE
OF
APPL.
Col. 6
COUNTY
CODE
Col. 7
Col. 8
Col. 9
ADDRESS
MUNICIPALITY (CITY, VILLAGE, ETC.)
ZIP CODE
Record Keeping Information
Row #
Dosage Rate
Method of Application
Target Organism
Place of Application
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
THIS INFORMATION SHOULD NOT BE SENT TO NYSDEC,
BUT MAY BE USED TO MEET RECORD KEEPING REQUIREMENTS.
New York State Department of Environmental Conservation
INSTRUCTIONS FOR APPLICATOR/TECHNICIAN...
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