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

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
Nozzle deflection (aerial only)		Carrier (water) volume
Product application rate
ASAE Spray Quality
On Product Label:		At Application:
Boom height greater than 0.6 m?		Boom pressure
Tractor speed or Air speed

Meteorological Conditions

Start time		Wind speed		Direction
Temperature (aerial only)			Relative humidity (aerial only)

Your Modified Site-Specific Buffer Zones

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