1. Application Information



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Date02.02.2017
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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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