Record keeping template Treatment of bees or beekeeping equipment with agricultural and veterinary chemicals reatment ate Product trade name No. of hives treated Volume of gas tight fumigation room or tarp covered space Location of apiary or beekeeping equipment Quantity of product used Treatment application rate Name and address of applicator 30/09/12 Broodmix (pre-mix) 50 100 Nectar Road, Bendigo 5 kg 100 g/hive Beekeeper ! 10 "ive #t, $%&'$*+$ *+ 3999 30/09/12 etraci n 100 #o..e oder (to e mixed ith cater gar) 100 11 o..en rack, a.pep 1 kg 100 g/hive Beekeeper! 10 "ive #t, $%&'$*+$ *+ 3999 30/09/12 4mitoxin coated inecticide ta.et 30 per 3 cic metre 26 ropo.i a7, $chca 56 ta.et 3 ta.et/2 cic metre Beekeeper! 10 "ive #t, $%&'$*+$ *+ 3999 30/09/12 8n.eaded petro. 25 1 "one7 #treet, $..inank 25 250 m/hive Beekeeper! 10 "ive #t, $%&'$*+$ *+ 3999 Always read the l abel before using any c hemical product Oxytetracycl ine hydrochloride (OTC) is the active constituent of the registered veterinary chemical product !roodmix" and is a #rescription Ani mal $emedy (%&) drug and must be prescribed by a registered veterinarian 'umitoxin coated insectici de tablets" are a % chemical and must only be used by persons holding a current Agricultur al Chemical ser #ermit (AC#) Agricultur al and veterinary chemical product details must be recorded ithin !" hours of use $ecords must be kept for two years *ote+ This template recognises the chemical applicator as the owner or an employee of the owner, -f the applicator is not the owner or their employee (i,e, person for whom the application was carried out). please record the owner/s name and address (note that a Commercial Operator s 0icence (CO0) is required if this is the case) This template meets the requirements under the Agricultural and 1eterinary Chemic als (Control of se) $egulations 233 and is a guide only 'or details of your legal requirements when using agricultural chemicals visit+ www.depi.vic.gov.au/chemicaluse