Record of Site-Specific Buffer Zone Modifications

Applicator and Business Name
Land Description
Crop and growth stage		Certification No.
Product Name		Registration No.
Application Date		Application Technique
Application notes:

Buffer Zones from Product Label

		Early Season	Late Season		Early Season	Late Season
Freshwater body	less than 1 m deep			greater than 1 m deep
Marine water body	less than 1 m deep			greater than 1 m deep
Terrestrial area

Sprayer Configuration

Equipment/Sprayer type		Nozzle type
Product application rate		Carrier (water) volume
ASAE Spray Quality
On Product Label:		At Application:
Tractor speed or Air speed		Boom pressure

Meteorological Conditions

Start time

Wind speed

Direction

Your Modified Site-Specific Buffer Zones

		Early Season	Late Season		Early Season	Late Season
Freshwater body	less than 1 m deep			greater than 1 m deep
Marine water body	less than 1 m deep			greater than 1 m deep
Terrestrial area