Government of Ontario: Ministry of the Environment

Summary of Planned and Completed Pesticide Aerial Applications in Ontario Crown Forests

This document satisfies the data reporting requirements of both the Crown Forest Sustainability Act and the Pesticides Act with regard to aerial pesticide applications in Crown Forests

For Ministry Use Only
Client Number

Management Unit Name
Plan Period
Annual Report Term
Year of Application
Application Type
Purpose of Application
Pesticide
PCP Number
Concentration grams/litre
Operator
Operator Licence Number
MOE Regional Office
MOE Permit Number

Spray Period

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

Site Application

1:20,000 Scale OBM Map Sheet Zone, East, North e.g. 16-30-535
Block

Pesticide Used

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

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number (Supplied by MOE Pesticides Specialist)

Spray Period

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

Site Application

1:20,000 Scale OBM Map Sheet Zone, East, North e.g. 16-30-535
Block

Pesticide Used

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

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number (Supplied by MOE Pesticides Specialist)

Spray Period

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

Site Application

1:20,000 Scale OBM Map Sheet Zone, East, North e.g. 16-30-535
Block

Pesticide Used

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

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number (Supplied by MOE Pesticides Specialist)

Spray Period

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

Site Application

1:20,000 Scale OBM Map Sheet Zone, East, North e.g. 16-30-535
Block

Pesticide Used

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

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number (Supplied by MOE Pesticides Specialist)

Spray Period

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

Site Application

1:20,000 Scale OBM Map Sheet Zone, East, North e.g. 16-30-535
Block

Pesticide Used

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

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number (Supplied by MOE Pesticides Specialist)

Spray Period

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

Site Application

1:20,000 Scale OBM Map Sheet Zone, East, North e.g. 16-30-535
Block

Pesticide Used

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

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number (Supplied by MOE Pesticides Specialist)

Spray Period

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

Site Application

1:20,000 Scale OBM Map Sheet Zone, East, North e.g. 16-30-535
Block

Pesticide Used

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

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number (Supplied by MOE Pesticides Specialist)

Spray Period

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

Site Application

1:20,000 Scale OBM Map Sheet Zone, East, North e.g. 16-30-535
Block

Pesticide Used

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

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number (Supplied by MOE Pesticides Specialist)

Spray Period

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

Site Application

1:20,000 Scale OBM Map Sheet Zone, East, North e.g. 16-30-535
Block

Pesticide Used

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

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number (Supplied by MOE Pesticides Specialist)

10.

Spray Period

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

Site Application

1:20,000 Scale OBM Map Sheet Zone, East, North e.g. 16-30-535
Block

Pesticide Used

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

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number (Supplied by MOE Pesticides Specialist)

11.

Spray Period

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

Site Application

1:20,000 Scale OBM Map Sheet Zone, East, North e.g. 16-30-535
Block

Pesticide Used

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

Exterminator

Name
Number

Aircraft Registration Number

Incidents / Complaints

Yes No
Reference Number (Supplied by MOE Pesticides Specialist)