U.S. EPA RESTRICTED USE Application Record Keeping Requirements Form Applicators must keep the following records for a period of two years (unless your state requires longer); records must be generated within 72 hours of application (unless your state requires shorter) and a record must be kept for each application to each field. Records must be made available to State Pesticide Control Official(s), USDA, and EPA upon request. The following information must be recorded and kept as required by the Federal Pesticide Record Keeping Program, 7 CFR Part 110: Full Name of Certified Applicator State Certification # for the Applicator

Product Name EPA Reg # Planting Date

I have purchase receipts (check for yes) I have a copy of the product label and state special local needs labels (check for yes)

(e.g., required for Commercial Target (s)(complete if required by your state) applicators in Iowa)

Sensitive record keeping requirements (see page 2) Before Application Date of or auxin-specific training completion 1 Provider

1 All applicators must complete dicamba or auxin-specific training before application via: 1) state-required training in state of application, 2) a registrant of a dicamba product approved for in- crop use with dicamba-tolerant , or 3) a state or state-authorized provider.

Date of Application Crop Location of the Application (field name or GPS coordinates)

How was the product applied? Preemergence Postemergence If post, how many days after planting?

Spray Nozzle Type Spray Pressure Describe the 110’ downwind buffer zone, and if required, the 57’ endangered species buffer zone Application

(List all , adjuvants, and other products - EPA Reg # only required for pesticides) Product2 EPA Reg # Product2 EPA Reg # es Tank Mix

2 Drop-down list includes approved BASF tank mix products and associated EPA Reg # only. See Engeniatankmix.com for complete list.

Engenia Rate/A (fl oz) Acres Treated Total Gallons Engenia Applied (÷ 128) =

Start Time End Time

Air Temperature Air Temperature Conditions º F (at boom height) º F (at boom height) Wind Speed mph Wind Speed mph (at boom height) (at boom height) Spraying Wind Direction Wind Direction

Date Method of cleanout t Before Application

After Application Clean ou

Engenia is a U.S. EPA . This form meets the RUP record keeping requirements for Engenia herbicide per the U.S. EPA label Reg No 7969-345, at “RESTRICTED USE PESTICIDE APPLICATION RECORD KEEPING AND TRAINING REQUIREMENTS.” Please check with your state pesticide regulatory authority as additional requirements may be imposed by your state.

ALWAYS READ AND FOLLOW LABEL DIRECTIONS. Engenia® is a registered trademark of BASF Corporation. © 2018 BASF Corporation. All Rights Reserved. Page 1 of 2 ALWAYS Engenia PESTICIDE

herbicide Sensitive Crop Record Keeping READ APPLICATION AND is a is Name ofsensitivecropregistryconsulted Date FOLLOW U. S EPA . neighboringfieldsweresurveyedforsusceptiblecrops RECORD LABEL restricted KEEPING DIRECTIONS. use pesticide. Federal PesticideRecordKeepingProgram,7CFRPart110 USDA, Official(s), for kept be must Applica AND DOCUMENT THE CROPS/AREAS SURROUNDING THE FIELD PRIOR TO PRIOR FIELD THE SURROUNDING CROPS/AREAS THE DOCUMENT TRAINING Engenia This t Application RecordKeepingRequirementsForm o

generated within generated r s form each ® must

REQUIREMENTS.” is a is meets the meets U.S. EPARESTRICTEDUSEPESTICIDE registered application keep and RUP t trademark EPA upon he record 72 Please following to hours keeping of

check with your with check BASF each request. records requirements of Corporation. field. application The state

for Records for ©

pesticide regulatory pesticide a 2018 Engenia following period (unless BASF herbicide must Corporation. of : information

two your per authority be

years the state

All U.S made Rights as must (unless additional EPA requires Reserved. label available be requirements your Reg recorded and kept as kept and recorded shorter) No

state 7969-345,

to APPLICATION Date

may State requires and be at imposed “RESTRICTED a Pesticide

record longer); required by required by your Page 2of

must USE state. records Control the be