STATE OF CALIFORNIA
MONTHLY SUMMARY PESTICIDE USE REPORT
PR-ENF-060 (REV. 4/92)
INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW DEPARTMENT OF PESTICIDE REGULATION
PESTICIDE ENFORCEMENT BRANCH OPERATOR (FIRM NAME) ADDRESS CITY ZIP CODE PHONE NUMBER OPERATOR ID/PERMIT NUMBER LICENSE NUMBER COUNTY WHERE APPLIED COUNTY NUMBER MONTH/YEAR OF USE TOTAL NUMBER OF APPLICATIONS 1. Complete Columns A, B, C, and D for All Users
2. Complete Column E by Using one of the Following Codes
Code 10 - Structural Pest Control..................................includes any pest control work performed within or on buildings and other structures.
Code 30 - Landscape Maintenance Pest Control..........includes any pest control work performed on landscape plantings around residences, or other buildings, golf courses, parks, cemeteries, etc.
Code 40 - Right-of-Way Pest Control............................includes any pest control work performed along roadsides, power lines, median strips, ditch bands and similar sites.
Code 50 - Public Health Pest Control............................includes any pest control work performed by or under contract with State or local public health or vector control agencies.
Code 80 - Vertebrate Pest Control................................includes any pest vertebrate pest control work performed by public agencies or work under the supervision of the State or county agricultural commissioner.
Code 91 - Commodity Fumigation (Nonfood/Nonfeed).includes fumigation of nonfood/nonfeed commodities such as pallets, dunnage, furniture, burlap bags, etc.
Code 100 - Regulatory Pest Control.............................includes any pest control work performed by public employees or contractors in the control of regulated pests.
3. Complete Columns F and G, if Use Does not Fit one of the Above Codes MANUFACTURER AND
NAME OF PRODUCT APPLIED A B C D E F G EPA/CALIFORNIA REGISTRATION NUMBER FROM LABEL (INCLUDE ALPHA CODE) ACRES/UNITS
TREATED COMMODITY OR SITE TREATED CODE NUMBER OF APPLICATIONS TOTAL PRODUCT USED
(Check One Unit of Measure) REPORT PREPARED BY DATE _ _ LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ LB OZ PT QT GA _ Reports must be submitted to the county agricultural commissioner by the 10th of the month following the month in which the work was performed.