AERIAL APPLICATION REQUEST FORM - Middlebrook Air · Date A/C Pilot Mixer Tacho Start Tacho Stop...
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Date A/C Pilot Mixer Tacho Start Tacho Stop Take-Off Landing Starts Landings Wind Dir Wind Speed OAT Humidity Swath M Postal Address: P.O. Box 317, Gunnedah. 2380 Australia iddlebrook Air Operations Pty. Ltd. A.C.N. 166 386 385 A.B.N. 89 166 386 385 PRICE/HA Office: Ph. 02 6744 5209 Fx. 02 6744 5284 UHF: Repeater 2 AERIAL APPLICATION REQUEST FORM Trading Name Contact Phone No Mobile Fax UHF Valid from / / Date of Order Preferred Time Preferred Wind Direction Recommendation Made by Valid to / / CHECKLIST 1. Are the agricultural chemicals you intend to use registered for aerial application and are the required application rates in accordance with the label recommendations? 2. Have you shown on the accompanying map the land use and vegetation type on ALL sides of the proposed treatment area? 3. Are there any houses, workplaces or any other inhabited buildings or sensitive areas over or near which the aircraft must not fly? 4. Are there any powerlines, windmills or other structures in the paddock to avoid? 5. Environmental conditions: Adjacent to the treatment area, are there any of the following which may be susceptible to, or contaminated by any of the products you intend applying? (Please circle) Crops Organic Farms Aquatic Farms Dams Trees School/Bus Pasture Bees Channels Roads Flora/Fauna Workers Contractors Livestock Vines Rivers Gardens Dwellings Towns Powerlines If you have answered in this column, or circled any of the above, please give additional information below. Circle as required YES NO YES NO NO YES NO YES NO YES ➤ ➤ ADDITIONAL INFORMATION CROP FIELD NAME (S) HA WEED/PEST CHEMICAL (S) RATES/HA WATER VOL SUPPLIER(S) FARM NAME OFFICE USE ONLY Fields Treated Dispersal Equipment Droplets Area Treated Marking System Airstrip Comments Applications will cease if conditions become unfavourable. Please SIGN and return this completed form to our company. BY SIGNING HERE YOU AGREE TO OUR TERMS AND CONDITIONS PRINTED ON REVERSE SIDE. I certify that the information provided in this checklist is to the best of my knowledge, complete and correct. Signature: Date: INVOICE No. WORK ORDER Email: [email protected]
Transcript of AERIAL APPLICATION REQUEST FORM - Middlebrook Air · Date A/C Pilot Mixer Tacho Start Tacho Stop...
Date A/C Pilot Mixer Tacho Start Tacho Stop Take-Off Landing Starts Landings Wind Dir Wind Speed OAT Humidity Swath
M Postal Address: P.O. Box 317, Gunnedah. 2380 Australia
iddlebrook Air Operations Pty. Ltd.A.C.N. 166 386 385 A.B.N. 89 166 386 385
PRICE/HAOffice: Ph. 02 6744 5209
Fx. 02 6744 5284
UHF: Repeater 2
AERIAL APPLICATION REQUEST FORM
Trading Name Contact Phone No Mobile Fax UHF Valid from / /
Date of Order Preferred Time Preferred Wind Direction Recommendation Made by Valid to / /
CHECKLIST1. Are the agricultural chemicals you intend to use registered for aerial application and are the required application rates in accordance with the label recommendations?
2. Have you shown on the accompanying map the land use and vegetation type on ALL sides of the proposed treatment area?
3. Are there any houses, workplaces or any other inhabited buildings or sensitive areas over or near which the aircraft must not fly?
4. Are there any powerlines, windmills or other structures in the paddock to avoid?
5. Environmental conditions: Adjacent to the treatment area, are there any of the following which may be susceptible to, or contaminated by any of the products you intend applying?
(Please circle)
Crops Organic Farms Aquatic Farms Dams Trees School/Bus Pasture Bees Channels Roads
Flora/Fauna Workers Contractors Livestock Vines Rivers Gardens Dwellings Towns Powerlines
If you have answered in this column, or circled any of the above, please give additional information below.
Circle as required
YES NOYES NO NO YES NO YES NO YES
➤➤
ADDITIONAL INFORMATION
CROP FIELD NAME (S) HA WEED/PEST CHEMICAL (S) RATES/HA WATER VOL SUPPLIER(S) FARM NAME
OFFICE USE ONLY
Fields Treated Dispersal Equipment Droplets Area Treated Marking System Airstrip Comments
Applications will cease if conditions become unfavourable.
Please SIGN and return this completed form to our company. BY SIGNING HERE YOU AGREE TO OUR TERMS AND CONDITIONS PRINTED ON REVERSE SIDE.
I certify that the information provided in this checklist is to the best of my knowledge, complete and correct. Signature: Date:
INVOICE No.
WORK ORDER
Email: [email protected]
