Parks & Recreation

Completed Boulevard Ash Injection Information - For Tree Care Providers

Company Name *

Company Address *

Applicator Name *

Applicator License # *

Customer Name *

Customer Address *

Number of pre-approved trees injected *

DBH of Tree(s) *

GPS Coordinates to 5 decimal places (xx.xxxxx) for each tree *

Date of Injection *

Start Time of injection *

End Time of injection *

Weather Conditions: temp, wind speed, wind direction *

Product Name *

Chemical Name *

EPA Reg. No *

Qty in mL for each tree *

Number of Injection holes for each tree *

Other Notes

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Duluth Parks & Recreation

Evergreen Community Center

5830 Grand Avenue

Duluth, MN 55807

218-730-4300

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