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PHC Daily Usage Form
For A Plus Applicators. ONE FORM PER PROPERTY. Please submit at the end of EVERY JOB.
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A Plus Tree, Inc | Pesticide License Number 40623
985 Walnut Ave, Vallejo CA 94592
Applicator Name
*
Choose
Jorge Ramirez
Greg Baza
Eric Luce
Salvador Jr
Ryan Ramirez
Pedro Meza
Michael Araujo
Jade Perez
Other
If name not listed
Your answer
Job#
*
Your answer
County
*
Your answer
Date of Application
*
MM
/
DD
/
YYYY
Time of application
*
Approximate
Early Morning (Before 8am)
Morning (9-11am)
Noon (12-2)
Afternoon (3-5pm)
Evening (After 6pm)
Product Used
*
Choose
Ace-Jet (EPA#74578-2-AA)
Atrimmec PGR (EPA# 2217-776-AA)
Baseline Insecticide (EPA# 279-3177-ZC
Cambistat 2SC (EPA# 100-1014-AA-74779)
Criterion 2F (EPA# 432-1312-ZA)
Criterion 75WSB (EPA# 432-1318-ZA)
Florel (EPA# 264-263-AA)
Garlon 4 Ultra (EPA# 62719-527-AA)
Mectinite (EPA# 74779-17-AA)
Merit 2F (EPA# 432-1312-AA)
Pentra Bark (EPA# 71962-50001-AA)
Propizol (EPA# 74578-8-AA)
Reliant (EPA# 83416-1-AA)
Safari 20 SG (EPA# 33657-16-AA-59639)
ShortStop 2SC (EPA# 62097-34-AA-82866)
Tree-Age G4 (EPA# 74578-10-AA)
Other
If product not listed
Your answer
Total Product Used (Number only)
*
Your answer
Unit
*
oz
gal
ml
ltr
qrts
Other:
Mix Rate
*
Your answer
Total Amount Applied
*
Your answer
Applying another product?
*
Yes
No
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