Government of Ontario: Ministry of the Environment

Summary of Planned and Completed Pesticide Aerial Applications

For Ministry Use Only
Client Number

Permit Application
Permit Year
MOE Permit Number
Crop
Purpose of Application
Pesticide
PCP Number
Concentration grams/litre
Operator
Operator Licence Number
MOE Regional Office

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Number of Applications
Application Rate in kg.(ai) per hectare
Proposed Size of Treatment Area (hectare)
Actual Size of Treatment Area (hectare)
Total Quantity of Pesticide product planned/used in kg. ai.

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number

10.

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number

11.

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number

12.

Spray Period

Start Date (dd/mm/yyyy) End Date (dd/mm/yyyy)

Site Application

UTM Coordinate of Centre of Field Datum-Zone-Easting-Northing
Location Identifier

Pesticide Used

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number