Pesticide Report * fields are required Marion Ag Service, Inc. Pesticide Report for: * Crop: * Variety: * Harvest Day: * Grower Name: * Lot Number: * Field No.: * Acres: * Field Location: * Please leave this field be PESTICIDES USED (including seed treatments) Date Applied Product Rate / Acre Thickness Method of Application Cleaning Records Clean Weight: Number of Sacks: Cleaning Equipment: Seed Location: Date Cleaned: Screening Disposal Site: Screening Disposal Method: Dirt Weight: Type of Sack: Salvage Weight: Screening Pound Total: Driver Name: Driver Signature: Questions About Something? We’re here to help! Contact Us