To
CSP Applicant:
(Applicant Name)
For
those cropland acres you wish to enroll in CSP, please answer the following
questions which determines the required minimum level of treatment.
1. 1. Are any insecticides, herbicides or fungicides applied on the cropland? If YES pesticides are a resource concern, complete remaining questions.
2. 2. The following herbicides have a WinPST risk assessment of intermediate, high, or very high risk of runoff or leaching in ground and surface water in this watershed. Check any of the following herbicides being used.
3. 3. If any of the above herbicides are used, is at least one of the following mitigation strategies (minimum level of treatment) used in each field where the above products are used? Check each mitigation strategy used:
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Active Ingredient |
Common Names |
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_____ |
Atrazine |
Numerous common named pesticides |
|
_____ |
Simazine |
Simazine, Pramitol |
|
_____ |
Alachlor |
Bullet, Intrro, Lariat, Lasso, Micro-Tech, |
|
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|
Partner |
|
_____ |
Mesotrione |
Callisto |
|
_____ |
Dimethenamid |
LeadOff (Frontier, Guardsman) |
|
_____ |
Acetochlor |
Fultime, Keystone, Surpass, Harness, |
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Confidence, Cadence, FieldMaster, Volley, |
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TopNotch, Degree |
|
_____ |
Pendimethalin |
Prowl, Hurdle, Pendimax, Pentagon, Pre-M, |
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Stealth |
_____a. A filter strip, or natural buffer a minimum of 25 ft. wide (30' if
slope > 5%) is maintained along all watercourses in any field where this product
is used.
_____b.
Greater than 30% residue is maintained on each non-buffered field
where these herbicides are used at the times of use.
_____c.
Application setbacks are used on any
fields where these herbicides are applied to non-buffered fields with less than
30% cover.
_____d. Less than 75% of maximum label rates are used on any field not
meeting one of the above criteria.
______e.
Are these pesticides incorporated, used only for spot treatment, or used no more
than once every third year?
4.
If you answered yes to number 2 and do not have at least one mitigation
strategy, these fields are not eligible for CSP.
If you believe that you meet the minimum treatment level requirements,
please complete the following Pest Management Inventory Worksheet. This
information will help us with assessing the benchmark condition for this land
use. An example is provided to assist you.
Example Pest Management Inventory Worksheet
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Tract & Field #s |
Type and Rate |
Mitigation
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Acres
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|
or Names |
of
Pesticide |
Strategy
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Application
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T486 – 1 |
Basis Gold 14 oz/ac. |
Application Setback |
25
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|
Smith farm – fld#2 |
Prowl 16 oz/ac |
Application Setback |
10 |
|
Attach Plan |
|
Total Acres: |
35 |
|
Maps |
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Nutrient Management Inventory Worksheet
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Tract & Field #s
or Names |
Type and Rate of
Pesticide Application |
Mitigation Strategy |
Acres
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Attach Plan Maps |
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Total Acres: |
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Certification
Statement
The
above information is correct to the best of my knowledge. I understand that if
requested, I can provide a minimum of two years of documentation to support the
information provided above.
Name:_________________________________
Date: ______________