1. REQUESTOR
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Name:
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*
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Affiliation:
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*
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Address:
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*
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City:
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*
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State:
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*
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Zip:
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*
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Telephone:
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*
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FAX:
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E-mail:
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*
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2. PEST CONTROL PRODUCT:
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Active Ingredient (a.i.):
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*
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Trade name/Formulation:
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Registrant (Manufacturer):
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Method of Production (fermentation, in vivo, extraction from plants):
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3. COMMODITY (one crop or crop group per form)
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Commodity:
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*
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Use Site (e.g., field, greenhouse, postharvest):
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Parts Consumed:
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Animal Feed By-Products:
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Planting Season:
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Harvest Season:
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State/Territory Acreage:
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% National Acres:
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Average Field Size:
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4. PEST/DISEASE/WEED/PLANT GROWTH REGULATOR:
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Damage caused by pest/disease/weed:
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5. WHY IS THIS USE NEEDED:
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*
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6. PROPOSED LABEL INSTRUCTIONS:
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Rate per Application (lbs a.i. per acre or 1000linear ft.)
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*
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Type of sprayers that may be used (e.g., fixed wing, ground boom sprayer, chemigation, air blast, ULV, granular spreader)
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Range of Spray Volume (if applicable)
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Maximum Acreage Treated per Day:
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*
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Crop Stage during Application(s):
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Maximum no. of applications:
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*
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Minimum interval between applications:
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Maximum lbs active ingredient per acre per year/season:
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PHI:
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7. AVAILABILITY OF SUPPORTING DATA:
*
*
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Phytotoxicity (P):
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Efficacy (E):
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Yield (Y):
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*
*
Send e-mail with attachments to
Bill Barney
after submission of this form.
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