Herbicide Report — Bella Terra

🌤 Weather Auto-Fill — Fetching current conditions from your location…

Project

Which project is this for? (fills contract #, county, route, area)

Prime Contractor (who Bella Terra subs under — blank if none)

Bella Terra is listed as the Subcontractor on the form. Whatever you type here is saved to the project for next time.

Application Information

Application Date

Contract Number

SR / Route Number

County

Description of Area Treated

Start Time

Finish Time

Equipment used

Handgun / wand nozzle Mitigation / restoration job

Chemical / Product Information

Herbicides applied — add each product used

Lot / batch # is the ink-jet code stamped on the jug (like NMSJRX0114 in the photo) — not the printed front label. On each row, tap 📷 Read lot # from photo and snap that stamped code — we'll read it for you.

Adjuvant / Additive (if used)

Adjuvant Name

Adjuvant EPA # / Amount

Environmental Conditions

Temp at Start (°F)

Temp at Finish (°F)

Wind Direction

Wind Speed (mph)

Weather Conditions

Precipitation

Applicator & Operator

Certified Applicator of record: Rena Bellika · Lic. 90840

Rena is the licensed applicator on every Bella Terra herbicide form. You are the operator who did the spraying.

Operator — who sprayed

Operator License # (blank if unlicensed)

Remarks / Target Pest / Additional Notes

🪪 Licensed Applicators — WA State

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Chemical Safety Data Sheets

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Chemical emergency: see the product's SDS for the manufacturer's 24-hr line (e.g. Bayer 1-800-334-7577)

✅ Report saved and emailed to Rena & Admin. DOT form attached as PDF.