U.S. EPA RESTRICTED USE PESTICIDE
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:
Date of Application
DT Crop
(List all pesticides, adjuvants, and other products - EPA Reg # only required for pesticides)
Product
2
EPA Reg # Product
2
EPA Reg #
Engenia Rate/A (fl oz)
Acres Treated
Total Gallons Engenia Applied
Start Time End Time
Air Temperature
º F
Air Temperature
º F
(at boom height) (at boom height)
Wind Speed
mph
Wind Speed
mph
(at boom height)
(at boom height)
Wind Direction Wind Direction
Date
Method of cleanout
Before ApplicationApplication Tank Mixes Spraying Conditions Cleanout
Provider
Before Application
After Application
2
Drop-down list includes approved BASF tank mix products and associated EPA Reg # only. See Engeniatankmix.com for complete list.
Engenia herbicide is a U.S. EPA RESTRICTED USE PESTICIDE. This form meets the RUP record keeping requirements for Engenia herbicide per the U.S. EPA label Reg No 7969-472, 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. © 2020 BASF Corporation. All Rights Reserved.
1
All applicators must complete dicamba 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 crops, or 3) a state-authorized provider.
(e.g., required for Commercial
applicators in Iowa)
State Certification # for the Applicator
Location of the Application
(field name or GPS coordinates)
How was the product applied? Preemergence
Spray Nozzle Type Spray Pressure
Postemergence
(÷ 128) =
Page 1 of 2
EPA Reg #
I have a copy of the product label and state special local needs labels
(check for yes)
Full Name of Certified Applicator
pH Buffering Adjuvant
Rate/A (fl oz)
Sensitive crop record keeping
requirements
(see page 2)
Engenia
Sentris or other approved pH buffering adjuvant
Approved DRA
(if required)
Product Name
Purchase receipts
(check for yes)
Date of dicamba training completion
1
Targ
et pest (s)
(complete if required by your state)
