1. Application Information

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Date	02.02.2017
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Fumigation Post-Application Summary
1. Application Information
Date of Application:
Time of Application:
Size of the Application Block:
2. Weather conditions
Describe the weather conditions at the time of application:
Wind speed:
Air stagnation:
Temperature:
Other:
Describe the weather conditions over the next 48 hours:
At 8 hours		At 16 hours:
Wind speed:		Wind Speed:
Air stagnation:		Air stagnation:
Temperature:		Temperature:
Other:		Other:
At 24 hours		At 32 hours:
Wind speed:		Wind Speed:
Air stagnation:		Air stagnation;
Temperature:		Temperature:
Other:		Other:
At 40 hours		At 48 hours:
Wind speed:		Wind Speed:
Air stagnation:		Air stagnation;
Temperature:		Temperature:
Other:		Other:
3. Tarp damage and repair information (if applicable):
Date when you found tarp damage:
Location and size of tarp damage:
Description of tarp, tarp seal and/or tarp equipment failure:
Date and time tarp was repaired:
4. Tarp perforation/removal details (if applicable):
Date and time tarps were perforated:
Date and time tarps were removed:
Record if tarps were perforated and/or removed early (as per conditions specified on the label). Describe the conditions that caused early tarp perforation and/or removal.
5. Complaint details (if applicable):
Name of Person Filing Complaint. on-site handler or person off-site
Contact information of the off-site person filing complaint: Address: _____________________________________ Phone Number: ________________________________
Description of the control measures or emergency procedures you followed after the complaint:
6. Description of incidents, equipment failure, or other emergency and emergency procedures you followed (if applicable).

7. Air monitoring results:
Sensory irritation
Date: Time:
Address:
Handler task/activity:
Resulting action: For example, did you implement an emergency response plan, cease operating, or continue operating with air-purifying respirators?
Sample details of direct read detection device:
Sample date	Sample time	Sample location	Concentration




Handler task/activity monitored (if applicable):
Resulting action. For example, did you cease operations or continue operations with air purifying respirators?
8. Fumigant Treated Area and Buffer Zone Signs:
Date signs were posted:
Date signs were removed:
9. Deviations from the Fumigation Management Plan
Describe any changes:
Emergency Response Actions:
Handler Information:
Handlers Responsible For Completing Emergency Tasks:
Communication Between Applicator, Owner/Operator, And Other Handlers:

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1. Application Information

Fumigation Post-Application Summary

2. Weather conditions

3. Tarp damage and repair information (if applicable):

4. Tarp perforation/removal details (if applicable):

5. Complaint details (if applicable):

6. Description of incidents, equipment failure, or other emergency and emergency procedures you followed (if applicable).

7. Air monitoring results:

8. Fumigant Treated Area and Buffer Zone Signs:

9. Deviations from the Fumigation Management Plan