State of Vermont s7

STATE OF VERMONT AGENCY OF AGRICULTURE, FOOD & MARKETS ARMES Division, Agency of Agriculture Jim Leland, Director Telephone: 1-802-828-6531 REQUEST FOR PERMIT TO CONDUCT RIGHTS-OF-WAY SPRAYING

Request is hereby made, pursuant to Title 6 V.S.A., Chapter 87, and the regulations issued pursuant thereto, for an approved permit to conduct spraying on rights-of-way within the State of Vermont.

A. General Information

1 . Title of Organization: Green Mountain Power Corp . 2. Address: 2152 Post Rd Rutland VT 05701 3. Telephone Number: 802-770-3231 4 Contact Person: Jarod Wilcox

5. Type of Right-of-Way:

X a. Electric Power Transmission Line b. Electric Power Distribution Line c. Telephone Line d. Highway e. Pipeline (Specify: Gas, Soil, Water) f. Railroad g. Airport Approaches and Safety Zones

6. Type of Treatment

X a. Selective Basal X b. Stump Treatment c. Dormant Cane (Broadcast Basal) d. Soil Applications (Soil Sterilant) e. Ground Broadcast Stem-Foliage f.Stem Injection (Frill Treatment) X g. Selective Low Volume Foliar

116 STATE STREET DRAWER 20 MONTPELIER, VT 05620-2901 Request for Permit to Conduct Rights-of-Way Spraying Page 2

7. Railroad Right-of-Way Treatment

a. Ballast

b. Shoulder

B. Site Specific Information

1. List Towns where Treatment will be Made:

(See Attachment B) Line

2. Total Acreage to be Treated Total Acres: 848

Ground Application Acres: 848

3. Width of Right-of-Way Feet: 50 -100

4. Width of Area In Right-of-Way to be Treated Feet: 50 -100

5. Anticipated Starting Date: May 22, 2017

C. Special Needs -

D. Treatment Within Buffer Strips

1. Specific Areas where Application is to be Made:

We plan to use Garlon® 4 Ultra to basal and stump treat hardwood trees to within 15 feet of

surface water.

2. Type of Vegetation to be Controlled: Incompatible deciduous woody species

3. Pesticide(s) to be Applied (List Here and in Section E): Garlon® 4 Ultra

4. Rate of Application (List Here and in Section E): 1 to 2 gal /acre or less Request for Permit to Conduct Rights-of-Way Spraying Page 3

5. Application Technique to be Implemented:

Low volume wand directly to stump or stem under low pressure.

6. Application Equipment to be Used:

Hand operated backpack .

7 Explain how this Request will Protect Sensitive Areas, Sensitive Crops, Site Conditions, Wells, etc.:

Risk of drift is minimized by hand pump/low volume

D. Contractor Information

1. Contractor's Name: Charlie Chapman

2. Company Name: Davey Tree Expert Company

3. Company Address: 2 South Park Street Lebanon, NH 03766 4. Current Vermont Applicator Certificate Number: 661-2421 ______

5. Company Telephone Number: Mobile: 603-443-7801 ______

1 . Contractor's Name: Jonathan Molleur______2. Company Name: New England Tree Experts _ ___

3. Company Address: PO Box 504______Hardwick, VT 05843______4. Current Vermont Applicator Certificate Number: _651-3663______5. Company Telephone Number: Office: 802-472-6646______

1. Contractor's Name: David O’Brien______2. Company Name: Lewis Tree Service Inc.______

3. Company Address: 13 Cottage St.______Belchertown, MA 01007______4. Current Vermont Applicator Certificate Number: __1102-3383______5. Company Telephone Number: Mobile: 413-237-9870______

1 . Contractor's Name: Sean MacPhee

Request for Permit to Conduct Rights-of-Way Spraying Page 3

2. Company Name: Asplundh Tree Experts ______

3. Company Address: 64 Steam Mill Road __ Auburn, NH 03032 ______4. Current Vermont Applicator Certificate Number: 70-2084 ______

5. Company Telephone Number: Mobile: 802-770-2458 ____ Request for Permit to Conduct Rights-of-Way Spraying Page 4

Control Details E. Control Details -Pesticides to be used, rates to be applied. If more than one chemical is listed, a summary of the uses intended for each chemical must be provided. The summary should state whether the chemical will be mixed or applied separately, specifying which chemicals will control what types of vegetation. (Please note: A copy of a label, MSDS Sheet and EPA Fact Sheet (if available) must be supplied for each chemical to be used.)

Trade Name Common Name of Active EPA Reg. No. Application Rate Vegetation to be Controlled Application Equip. to be Used Potential Adjuvants

Ingredient(s) Product/Acre Undesirable trees and brush, Low volume hand operated 1 to 2 gal/acre Arborchem Basal Oil, Arborchem Garlon® 4 Ultra Triclopyr 62719-527 i.e., poplars, maples, oak, ash, backpack, low pressure spray 20% by volume cherry, and elm units Clean Cut Undesirable trees and brush, Low volume hand pump Escort® XP Metsulfuron Methyl 432-1549 0.50 to 2 oz./acre i.e., poplars, maples, oak, ash, Thinvert® RTU backpack cherry, and elm Undesirable trees and brush, Isopropylamine Salt of 0.25 to 2.0 gal/acre or Low volume hand pump Rodeo® 62719-324 i.e., poplars, maples, oak, ash, Thinvert® RTU Glyphosate less backpack cherry, and elm Undesirable trees and brush, Isopropylamine Salt of Low volume hand pump Polaris® 228-534 6 pints/acre or less i.e., poplars, maples, oak, ash, Thinvert® RTU Imazapyr backpack cherry, and elm Undesirable trees and brush, Ammonium Salt of 0.5 to 3.0 gal/acre or less Low volume hand pump Krenite® S 42750-247 i.e., poplars, maples, oak, ash, Thinvert® RTU Fosamine – 41.5% – low volume backpack cherry, hemlock, elm

Potassium Salt of Undesirable trees and brush, Low volume hand pump Method® 240SL Aminocyclopyrachlor – 432-1565 18 oz./acre or less i.e., poplars, maples, oak, ash, Thinvert® RTU backpack 25% elm Request for Permit to Conduct Rights-of-Way Spraying Page 5

F. Methods of Notification

1 List the Newspapers in which you will advertise this Application to Comply with Section IV, 4.b., of the Vermont Regulations for Control of Pesticides.

a) See Attachment D______

Also see sample Ad Format______

2 Please Indicate Other Notification Option Chosen to Comply with Section IV, 4.c, of the Vermont Regulations for Control of Pesticides.

Our second method of Notification will be U.S. Mail to residents adjacent to the right-of-way. When practical, an effort will be made to personally notify the individual property owner when working in area.

a) See Attachment E______

G. Other Information To Be Submitted With Application

1. Two (2) Sets of Geodetic (in 7.5 minute scale) or Orthophoto Maps indicating the Right-of-Way to be Treated. (Only one set of maps is needed if maps have been previously submitted and revisions have not been made.)

2. Current Labeling for each Pesticide to be Used.

3. Current Material Safety Data Sheet (MSDS) for each Pesticide to be Used.

4. Current Environmental Protection Agency Pesticide Fact Sheet (if available).

The undersigned accepts full responsibility for all statutes and regulations of the State of Vermont and understands that any authorization is limited to the described materials, locations and time periods stated herein.

The undersigned further understands that weekly spray and dusting operations must be reported to the Vermont Department of Agriculture. Such written report shall be on forms furnished by the Commissioner of Agriculture and placed in the mail not later than the close of business on the Monday following the week's operation.

Date ______Signature of Applicant______

(NOTE: Additional sheets may be attached to include further information.) Attachment A

Green Mountain Power Corporation 2017 Integrated Vegetation Management Program Type of Treatment

Selective Low Volume Foliar - This refers to selective treatment of identified uncompatible brush during the growing season in a manner to preserve desirable shrub and plant species. Most effective application technique to target individual plants for control while minimizing usage rates.

General Comments:

In the foliar season, both the selective basal and foliar methods of brush control will be used.

In the dormant season the primary mode of treatment will be selective basal (a).

Stump treatment (b) will be used only in isolated sensitive areas such as roadsides, hedgerows, near residences and where tall isolated clumps must be cut. Stump treating may be done throughout the spray season. Green Mountain Power Corporation 2017 Integrated Vegetation Management Program Line ROW Total Treatable Number Line Name Miles Acres Acres 54 N. Rutland - S. Rutland 5.22 63.27 35 55 E. Rutland - Tap 0.52 6.3 3 56 S. Rutland - Cold River (Velco) 2.7 32.72 27 56B G. E. Tap 0.91 11.03 3 57 Wallingford Tap 2.83 34.3 20 58 Cold River (Velco) - Mt. Holly 12.75 154.55 96 58A Mt. Holly - Ludlow 7.62 92.36 26 59 Ludlow - Cavendish 5.13 62.18 50 62 N. Rutland - Pittsford 4.76 57.7 34 63 Mendon Tap 3.07 37.21 27 65 Brandon - Pittsford 11.78 142.79 78 91 Cavendish - Ascutney 9.75 118.18 89 92 Ascutney - Claremont 1.1 13.33 VT 12 3.39 41.09 NH 37 93 Cavendish - Springfield 11.13 134.91 93 94 Chester Tap 4 48.48 24 95 N. Springfield Tap 0.7 8.48 7 96 Riverside Tap 0.4 4.85 0 97 Fellows Gearshaper Tap 0.25 3.03 1 98 N. Springfield - Ascutney 8.61 104.36 81 99 Springfield - Conn. River 4.86 58.91 37 100 Brownsville Tap 3.81 46.18 18 102 Claremont - Charlestown 12.89 156.24 NH 74 104 Claremont - Windsor 6.06 73.45 NH 43 3303 Berlin #5 to Middlesex #2 5.18 62.79 3331 Bolton #41 to Middlesex #2 8.49 102.9 3310 Montpelier #3 - Irasville #39 - Middlesex #2 33.64 407.76 3312 Middlesex #2 - Duxbury Switch 9.84 119.27 3313 Little River #22-Stowe- Waterbury#47 9.77 118.42 3327 Madbush #38 - Irasville #39 3.54 42.91

TOTALS: 194.86 2361.89 VT 761 NH 154 2016 Maintenance Program Cut & Mowed 2017 Follow Up Herbicide Application

Line ROW Total Treatable Number Line Name Miles Acres Acres Acres 6670 Searsburg #92 - N. Grid 1.43 17.33 15 6671 Wilmington #56- Dover #90 7.31 88.61 60 6672 Wilmington #56 Tap 1.80 21.82 12 Green Mountain Power Corporation 2017 Integrated Vegetation Management Program Control Details

Garlon ® 4 Ultra

Manufactured by Dow Agrosciences, EPA Registration # 62719-527

Garlon® 4 Ultra is a new low-odor, non-petroleum, plant-derived methylated seed oil (MSO) solvent with demonstrated increased efficacy on multiple woody species. Garlon® 4 Ultra will be applied with basal oils such as Arborchem Basal Oil, Arborchem NPD or HY- GRADE I™. The oils act as a carrier and penetrant to cut stump surfaces. It may also be applied as a Selective Stem Basal Treatment. Garlon® 4 Ultra is applied to stumps and stems via low volume wand.

Garlon® 4 Ultra is also designed to be used on a woody plant species during the dormant season. It will not be applied to frozen or snow covered ground.

Escort ® XP

Manufactured by Bayer, EPA Registration #432-1549

Escort® XP is commonly used in tank mixes with other foliar herbicides for broad spectrum species control. This product will be mixed with a drift control and/or surfactant such as Thinvert®.

Polaris®

Manufactured by NuFarm, EPA Registration #228-534

Polaris® is commonly used in tank mixes with other foliar herbicides for broad-spectrum species control. This product will be mixed with a drift control and/or surfactanct such as Thinvert®.

Rodeo ®

Manufactured by Dow Agrosciences, EPA Registration #62719-324

Rodeo® is applied to the foliage in the summer and early fall.

Rodeo® will be tank mixed with Polaris® and/or Escort® XP for both low and ultra low volume foliar applications. Tank mixing allows for a broader spectrum of control while reducing rates per acre.

This product will be mixed with a drift control and/or surfactant such as Thinvert®. Krenite® S

Manufactured by Albaugh Inc, EPA registration #42750-247

Krenite® S is applied to the foliage in summer and early fall. Following application there is little, if any, brown out and no leaf-out the following year.

This material depends on leaf absorption. The tank mix of Krenite® S with Polaris® gives a broader spectrum of control on species such as yellow poplar, cherry, maple and hemlock where Krenite® S alone is not as effective.

This product will be mixed with Thinvert®, a paraffin oil blend and emulsifier or water.

Method® 240SL

Manufactured by Bayer, EPA registration #432-1565

Method® 240LS is applied to foliage in summer and early fall.

Method® 240LS will be tank mixed with Polaris® and/or Escort® XP for both low and ultra low volume foliar applications. Tank mixing allows for a broader spectrum of control while reducing rates per acre.

This product will be mixed with a drift control and/or surfactant such as Thinvert®.

Thinvert® RTU (Ready to Use)

Is a combination of phyto-bland paraffinic oil blended with emulsifier, surfactant and water to form a thin invert emulsion that is applied withULV nozzles. It replaces water as the carrier of herbicide products. THINVERT® keeps the herbicide solution wet on the plant for a long period of time, ensuring penetration and a high percentage of control all while minimizing the potential of drift. Green Mountain Power Corporation 2017 Integrated Vegetation Management Program Newspaper Advertising

Ad Group County Newspaper Line Name Towns Involved 1NT-2017BR Winham Brattleboro Reformer Wilmington - Dover Wilmington, Dover 2NT-2017DV Deerfield Valley News Wilmington Tap Wilmington

3NT-2017RH Bennington Rutland Herald Searsburg - N. Grid Searsburg 4NT-2017BB Rutland Bennington Banner N.Rutland –S.Rutland Rutland Town 6NT-2017BFP Burlington Free Press E.Rutland Tap Rutland City S.Rutland – Cold River Rutland Town, Clarenden G.E.Tap Rutland Town, Clarendon Wallingford Tap Wallingford, Clarendon Cold River-Mt.Holly Clarendon, Mt.Holly, Shrewsbury, Wallingford Mt.Holly-Ludlow Mt.Holly N.Rutland-Pittsford Pittsford, Rutland Town Mendon Tap Rutland Town, Mendon Brandon-Pittsford Brandon, Pittsford, Chittenden

7NT-2017VN Windsor The Valley News Mt.Holly-Ludlow Ludlow 2NT-2017DV Deerfield Valley News Ludlow-Cavendish Cavendish, Ludlow Cavendish-Ascutney Cavendish, Weathersfield Ascutney-Claremont Weathersfield Cavendish-Springfield Cavendish, Springfield, Chester Chester Tap Chester N.Springfield Tap Springfield Riverside Tap Springfield Fellows Gearshaper Tap Springfield N.Springfield-Ascutey Weathersfield, Springfield Springfield-Conn.River Springfield Brownsville Tap Weathersfield, West Windsor 6NT-2017BFP Washington Burlington Free Press Berlin-Middlesex Moretown, Berlin 8NT-2017TA Lamoille Times Argus Bolton-Bolton Falls-Middlesex Bolton, Waterbury, Duxbury, Moretown Montpelier-Irasville-Middlesex Berlin,Northfield,Waitsfield,Moretown,Fayston,Montpelier Middlesex-Duxbury Moretown, Duxbury, Waterbury Little River-Stowe-Waterbury Stowe, Waterbury Madbush-Irasville Fayston, Warren Attachment D (Cont’d)

SAMPLE AD FORMAT- Brattleboro Reformer

PUBLIC NOTICE

INTENT TO APPLY HERBICIDES Green Mountain Power Corporation, 2152 Post Rd, Rutland, Vermont 05701 has applied for a permit from the Vermont Secretary of Agriculture to apply herbicides. All herbicides will be applied by ground-based, hand-held equipment. This notice constitutes a warning to residents along the right-of-way that water supplies and other environmentally sensitive areas near the right-of-way should be protected from spray and that it is the resident’s responsibility to notify the contact person of the existence of a private water supply near the right-of-way. The contact person at GMP is Jarod Wilcox, Transmission Arborist, (802) 770-3231. Further information may also be obtained from Plant Industry Division, Vermont Agency of Agriculture, 116 State Street, Montpelier, Vermont 05620-2901, telephone (802) 828-2431.

Operations will commence on or about May 22, 2017 using one or more of the following herbicides: Garlon 4 Ultra (triclopyr), Escort XP (metsulfuron methyl), Polaris (imazapyr), Rodeo (glyphosate) & Method 240SL (aminocyclopyrachlor)

Maintenance will be conducted on the following transmission lines in the following towns: Lines: Town(s): Wilmington - Dover Wilmington, Dover Wilmington Tap Wilmington

Green Mountain Power 2152 Post Rd. Rutland, VT 05701

1NT-17BR

ttachment D (Cont’d

SAMPLE AD FORMAT- Deerfield Valley News

PUBLIC NOTICE

INTENT TO APPLY HERBICIDES Green Mountain Power Corporation, 2152 Post Rd Rutland, Vermont 05701 has applied for a permit from the Vermont Secretary of Agriculture to apply herbicides. All herbicides will be applied by ground-based, hand-held equipment. This notice constitutes a warning to residents along the right-of-way that water supplies and other environmentally sensitive areas near the right-of-way should be protected from spray and that it is the resident’s responsibility to notify the contact person of the existence of a private water supply near the right-of-way. The contact person at GMP is Jarod Wilcox, Transmission Arborist, (802) 770-3231. Further information may also be obtained from Plant Industry Division, Vermont Agency of Agriculture, 116 State Street, Montpelier, Vermont 05620-2901, telephone (802) 828-2431.

Maintenance will be conducted on the following transmission lines in the following towns: Lines: Town(s): Wilmington - Dover Wilmington, Dover Wilmington Tap Wilmington Mt.Holly-Ludlow Ludlow Ludlow-Cavendish Cavendish, Ludlow Cavendish-Ascutney Cavendish, Weathersfield Ascutney-Claremont Weathersfield Cavendish-Springfield Cavendish, Springfield, Chester Chester Tap Chester N.SpringfieldTap Springfield Riverside Tap Springfield Fellows Gearshaper Tap Springfield N.Springfield-Ascutney Weathersfield, Springfield Springfield-Conn. River Springfield Brownsville Tap Weathersfield, West Windsor Windsor Mfg Tap Windsor

Green Mountain Power 2152 Post Rd Rutland, VT 05701

2NT-17DV

ttachment D (Cont’d

SAMPLE AD FORMAT- Rutland Herald

PUBLIC NOTICE

Operations will commence on or about May 22, 2017 using one or more of the following herbicides: Garlon 4 Ultra (triclopyr), Escort XP (metsulfuron methyl), Polaris (imazapyr) Rodeo (glyphosate) & Method 240SL (aminocyclopyrachlor) .

Maintenance will be conducted on the following transmission lines in the following towns: Lines: Town(s): Searsburg-N.Grid Searsburg N.Rutland-S.Rutland Rutland Town E.Rutland Tap Rutland City G.E. Tap Rutland Town, Clarendon Wallingford Tap Wallingford, Clarendon Cold River-Mt.Holly Clarendon,Mt.Holly,Shrewsbury,Wallingford Mt.Holly-Ludlow Mt.Holly N.Rutland-Pittsford Pittsford, Rutland Town Mendon Tap Rutland Town, Mendon Brandon-Pittsford Brandon, Pittsford, Chittenden S.Rutland-Cold River Rutland Town, Clarendon

3NT-17RH ttachment D (Cont’d

SAMPLE AD FORMAT- Bennington Banner SAMPLE AD FORMAT

PUBLIC NOTICE

Maintenance will be conducted on the following transmission lines in the following towns: Lines: Town(s): Searsburg - N. Grid Searsburg

4NT-17BB ttachment D (Cont’d

SAMPLE AD FORMAT- The Times Argus

PUBLIC NOTICE

Maintenance will be conducted on the following transmission lines in the following towns: Lines: Town(s): Berlin-Middlesex Moretown, Berlin Bolton-Middlesex Bolton,Waterbury,Duxbury,Moretown Middlesex-Duxbury Moretown, Duxbury, Waterbury Little River-Stowe-Waterbury Stowe, Waterbury Madbush-Irasville Fayston,Warren Montpelier-Irasville-Middlesex Berlin,Northfield,Waitsfield,Moretown,Fayston & Montpelier

8NT-17TA ttachment D (Cont’d

SAMPLE AD FORMAT- Burlington Free Press

PUBLIC NOTICE

Maintenance will be conducted on the following transmission lines in the following towns: Lines: Town(s): Searsburg-N.Grid Searsburg N.Rutland-S.Rutland Rutland Town E.Rutland Tap Rutland City S.Rutland-Cold River Rutland Town, Clarendon G.E. Tap Rutland Town, Clarendon Wallingford Tap Wallingford, Clarendon Cold River-Mt.Holly Clarendon,Mt.Holly,Shrewsbury,Wallingford Mt.Holly-Ludlow Mt.Holly N.Rutland-Pittsford Pittsford, Rutland Town Mendon Tap Rutland Town, Mendon Brandon-Pittsford Brandon, Pittsford, Chittenden Berlin-Middlesex Moretown, Berlin Bolton-Middlesex Bolton,Waterbury,Duxbury,Moretown Middlesex-Duxbury Moretown, Duxbury, Waterbury Little River-Waterbury-Stowe Stowe, Waterbury Madbush-Irasville Fayston, Warren Montpelier-Irasville-Middlesex Berlin,Northfield,Waitsfield,Moretown,Fayston & Montpelier

6NT-17BFP

SAMPLE AD FORMAT- The Valley News ttachment D (Cont’d

PUBLIC NOTICE

Maintenance will be conducted on the following transmission lines in the following towns: Lines: Town(s): Mt.Holly-Ludlow Ludlow Ludlow- Cavendish Cavendish, Ludlow Cavendish-Ascutney Cavendish, Weathersfield Ascutney-Claremont Weathersfield Cavendish-Springfield Cavendish, Springfield, Chester Chester Tap Chester N.Springfield Tap Springfield Riverside Tap Springfield Fellows Gearshaper Tap Springfield N.Springfield-Ascutney Weathersfield, Springfield Springfield-Conn River Springfield Brownsville Tap Weathersfield, West Windsor Windsor Mfg Tap Windsor

7NT-17VN

PUBLIC NOTICE PUBLIC NOTICE HERBICIDE USE NOTIFICATION

Vermont utilities maintain electric line rights-of-way with several methods, including the selective use of herbicides on trees and brush. They also encourage low-growing shrubs and trees which will crowd tall-growing species and, thus, minimize the use of herbicides. The application of herbicides may start as early as April 1. If you own or occupy land within 1000 feet of a utility right of way, you may request in writing to be notified when the line will be treated with herbicides. Written requests for placement on the mailing list must be received by the utility by February 15. Additionally, it is the landowner’s duty to inform the utility in writing of any potentially affected water supply and any environmentally sensitive areas where herbicide application should be avoided

The Public Service Board requires Vermont utilities to carry out vegetation management techniques which allow maintenance of electrical systems in a cost-efficient manner. The types of herbicide treatment used to maintain vegetation on utility rights-of-way include the following applications: stump, injection, basal, soil, and foliar. These are the commonly used methods; your local utility may use other methods. Landowners have the right to request that a utility apply herbicide treatment on cut stumps only or that a utility refrain from applying herbicide. In the latter case, the landowner has to pay the utility an administrative fee. Only electric utility rights- of-way that have tall-growing tree species with the potential of threatening the electric utility system are treated.

Utilities advertise by radio and newspaper prior to herbicide applications on all lines. Utilities typically treat rights of way once every four-to-six years, depending on the utility’s specific vegetation management cycle. Please check with your utility regarding the vegetation management cycle of a particular line.

Some utilities identify their poles with metal letters and numbers, e.g., V.E.C. (Vermont Electric Co-operative), or V.E.L.C.O. (Vermont Electric Power Company). These markings are not found on every utility pole. However, by checking of several poles on a line, you should be able to find a marked pole and determine which utility owns it.

Persons owning or occupying land within 1,000 feet of a utility right-of-way may request in writing that the utility notify them individually by mail anytime but at least 30 days prior to treatment of the line with herbicides. The landowner or resident is responsible for contacting the utility, in writing, to request placement on the mailing list. The utility should be provided with sufficient information as to the exact location of the residence and land. It is the duty of each landowner or resident to make the utility aware of the location of any potentially affected water supply, and any environmentally sensitive areas where herbicide application ought to be avoided.

CONTACT YOUR ELECTRIC UTILITY WITH QUESTIONS OR SUBMIT THE COUPON PROVIDED

If you have further questions or concerns contact:

Agency of Agriculture Consumer Affairs & Public Information Cary Giguere Dept. of Public Service 116 State St., Montpelier, VT 05602 112 State St., Montpelier, VT 05620 1-802-828-6531 1-800-622-4496 or 1-802-828- 2332

LANDOWNER REQUEST TO BE ADDED TO HERBICIDE TREATMENT NOTIFICATION MAILING LIST

Name Town/City of Affected Property

Street Address Telephone Number (Home)

Town (Work)

State Zip Code O.K. to use Work Number: Yes No

Electric Account Number Best Time to Call

Property of Concern: Year Round Residence Summer Residence Commercial Property

Water Supply Land Other

Line and Pole Identification: Utility Initials Numbers

We need all of this information in order to determine if you qualify for personal notification. If information is unobtainable, please state why. Use an extra sheet of paper if you need more space. RETURN TO YOUR LOCAL UTILITY VELCO17