Maine Board of Pesticides Control Bt Corn Records Log Sheet*	Year:
Total Acres Bt Corn Planted:
Total Acres Refuge Planted:	
Bt Certificate Holder Name/Number:    		
Seed Planter’s Name:    		
Field Name	Town	Field 
Location	Map**	Bt Corn
 Brand Name	EPA Number	DATE PLANTED	TIME PLANTED	SIZE (ACRES)	SeedS/ACRE	
						Bt Field	Refuge	Bt Field	Refuge	Bt Field	Refuge	Bt Field	Refuge	
Home	Thorndike	Smith Road	ü	Joe’s Bt Corn IV	1111-2222	5/12/09	5/12/09	6:00 am	6:30 am	100	20	30,000	30,000	

														

														

														
*Note: Other pesticide applications made to Bt-corn fields or refuges must be recorded in the regular pesticide application log.
**A map must be attached showing the Bt-corn crop location, layout of the refuge, and location of any known adjacent crops within 500 feet that are susceptible to cross-pollination.