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Aquatic Plant and Algae Management General Permit Treatment Notice TemplatesPlease follow the instructions on this cover page when filling in treatment notices.
The first page is a generic template for aquatic pesticide and other treatment notices for the Aquatic Plant and Algae Management general permit. Individual chemical templates are included in this document for each chemical approved under the general permit. You may also use this generic template and customize it to match the requirements for each treatment product. Check the FIFRA label for each chemical to ensure you are displaying the correct use restrictions. For questions on how to use the templates, contact Kimberly Adams at [email protected], or call (360) 407-6448.
Pictograms: Pictograms are required for each use restriction. You can add or remove pictograms to each treatment notice as appropriate. The pictograms are defined in the table on the second page of this document.
Signal words: refer to the product label for the correct signal word (e.g. Caution, Warning, etc.). Herbicide Name: Include the name of the herbicide, biological clarifying agent, shading agent, or
phosphorus sequestration product. Treatment Date: Include the date the treatment will take place. Use Restrictions: Refer to the product label for additional use restrictions (e.g. fishing, irrigation,
livestock etc.). If you use one of the prepared templates, refer to the product label and add any missing use restrictions and hazards. For each use restriction, include the number of days from the treatment the restriction will be in place and the date on which the activity can resume.
Contact Information: Include the name and contact phone number for the treatment applicator and property manager.
Hazards: Refer to the product label for hazards (e.g. dermal irritation, eye irritation, etc.). Permit Number: Fill in your permit coverage number.
Description of Use Restrictions for Notice Sign Pictograms
Pictogram Use RestrictionDo not use water for irrigation.
Do not wade or play in the water; avoid skin contact with water.
Do not fish; do not consume fish caught in this water body.
Do not drink the water; do not use the water as a drinking water source.
Do not swim; avoid skin, eye, nose, and mouth contact with the water.
Do not allow pets or livestock to enter or drink the water; avoid any water contact with pets or livestock.
CAUTION: HERBICIDE NAME APPLICATION ON XX/XX/XX
XX Days XX Days
May resume use on: DATE
May resume use on: DATE
XX Days XX Days
May resume use on: DATE
May resume use on: DATE
XX Days XX Days
May resume use on: DATE
May resume use on: DATE
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
Due to the possibility of [LIST POTENTIAL HAZARDS], Ecology suggests not using the area behind the signs after treatment until the date listed, or these signs are removed by the Applicator.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: 2,4-D (Amine) Application ON XX/XX/XX
XX Days XX Days
May resume use on: DATE
May resume use on: DATE
XX DaysAPPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
May resume use on: DATE
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
Due to the possibility of eye irritation, Ecology suggests not using the area behind the signs after treatment until the date listed, or these signs are removed by the Applicator.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: 2,4-D (Ester) Application ON XX/XX/XX
XX Days XX Days
May resume use on: DATE
May resume use on: DATE
XX DaysAPPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
May resume use on: DATE
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
Due to the possibility of eye irritation, Ecology suggests not using the area behind the signs after treatment until the date listed, or these signs are removed by the Applicator.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Aminopyralid ApplicationON XX/XX/XX
XX Days
May resume use on: DATE
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
Due to the possibility of eye irritation, Ecology suggests not using the area behind the signs after treatment until the date listed, or these signs are removed by the Applicator.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: BIOLOGICAL WATER CLARIFIER (NAME OF CLARIFIER) APPLICATION
ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Bispyribac-sodium Application ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Carfentrazone-ethyl ApplicationON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Diquat Dibromide Application ON XX/XX/XX
XX Days
May resume use on: DATE
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
Due to the possibility of eye irritation, Ecology suggests not using the area behind the signs after treatment until the date listed, or these signs are removed by the Applicator.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Endothall (Dipotassium Salt) Application
ON XX/XX/XX
XX Days
May resume use on: DATE
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
Due to the possibility of eye irritation, Ecology suggests not using the area behind the signs after treatment until the date listed, or these signs are removed by the Applicator.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
WARNING: Endothall (Hydrothol 191™) Application
ON XX/XX/XX
XX Days
May resume use on: DATE
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
Due to the possibility of eye irritation, Ecology suggests not using the area behind the signs after treatment until the date listed, or these signs are removed by the Applicator.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Florpyrauxifen-benzyl Application
ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Flumioxazin Application ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlant
CAUTION: Glyphosate Application ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Fluridone Application ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions. .
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Imazamox Application ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Imazapyr Application ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Penoxsulam Application ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Peroxyacetic/Peracetic Acid Application
ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: SHADING PRODUCT (PRODUCT NAME) APPLICATION
ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Sodium Carbonate Peroxyhydrate Application
ON XX/XX/XX
XX Days APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARYMay resume use
on: DATE
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
Due to the possibility of eye irritation, Ecology suggests not using the area behind the signs after treatment until the date listed, or these signs are removed by the Applicator.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Topramezone Application ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: Triclopyr TEA Application ON XX/XX/XX
XX Days APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARYMay resume use
on: DATE
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
Due to the possibility of eye irritation, Ecology suggests not using the area behind the signs after treatment until the date
listed, or these signs are removed by the Applicator.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
CAUTION: PHOSPHORUS SEQUESTRATION PRODUCT APPLICATION
ON XX/XX/XX
APPLICATOR TO ADD ADDITIONAL LABEL
RESTRICTIONS IF NECESSARY
Project Proponents:
Applicator Contact: APPLICATOR NAME, (XXX) XXX-XXXX
Property Manager: PROPERTY MANAGER, (XXX) XXX-XXXX
There are no swimming or recreation restrictions.
Aquatic Treatment Regulated Under Permit No. WAG99XXXX Issued By:
While Ecology issues the permit to protect all water uses, even if uses are temporarily diminished, the project proponents selected the management method.
Permit Information: ecology.wa.gov/AquaticPlants
