Plant Industry Division

Name:  Enter Certified Applicator name as it appears on the certification card.

Certification #:  Enter the number associated with the Certified Applicator certification card.

Reporting Year:  Current year for which records are being kept.

Phone:  Phone number which the applicator can be most easily reached in case any questions arise regarding the information submitted.

Email:  Most up-to-date email associated with the Certified Applicator.

Permit number(s):  Any permit number or numbers that are associated with a specific RUP application.  For most cases this will be left blank.

Product Name:  The name of the pesticide product as it appears on the label.

EPA Registration Number:  EPA Registration Number associated with the product that was applied.

Formulation:  Formulation of the RUP product.

Active Ingredient(s) and percent:  Enter the name of the active ingredient found on the product label along with the percentage of active ingredient in the product, e.g. Esfenvalerate 8.4% for insecticide Asana.

Pest:  Target pest of the RUP application.

Dilution Rate:  Amount of solution that the RUP was mixed into, if appropriate, e.g. 1 oz in 40 gallons of water expressed as 1 oz RUP/40 gallons of water.

Total Used (lbs, oz, pt, qt, gal):  Total amount of the RUP product used expressed in pounds and/or ounces for dry material, or ounces, pint, quart, gallon (or some fraction of a gallon or other unit, e.g. ml).

Area Treated (ac, sq ft):  Total amount of area treated with the product in acres, square feet, or cubic feet.

Time Applied:  Time of day that the RUP was applied.

Date Applied:  Date on which the application for the RUP product in this row is applied.

Crop or Site:  Crop or object, such as whole house fumigation, on which the RUP was applied.

REI:  Restricted Entry Interval or amount of time from when the RUP application was finished to when a worker can enter the treated area, usually in hours.

Oral Notification Required (Y or N):  Was oral notification to employees or others required for the RUP product applied?

Tax Map Key(s):  TMK or TMKs (if applicable) must be entered for the application location.  Additional information, such as street address can be listed, if desired, in addition to the TMK but TMK is required.

County:  County in which the application was made.  For Maui County it is not required to break it down by islands within the County.  For Kauai County it is not required to break it down by islands within the County.

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When completed at the end of the reporting year, send FORM P-45, Part 2, Report Summary and Form P-45 Part 1, Report Declaration by January 30^th of the following year to the Pesticides Branch at [email protected]

If you have any questions about this, please contact the Pesticides Branch at (808) 973-9402 or email at [email protected]