FS-2100-0002 Pesticide-Use Proposal.pdf
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- Solicitation number
- 1240BE26Q0035
About this file
This is a USDA Forest Service Pesticide-Use Proposal Form (FS-2100-0002, Rev. 02/2019) submitted on February 14, 2019, for a bark beetle prevention project at Smokey Campground in the Big Lake Ranger District of Canoe National Forest, Montana (Missoula County), Region 7.
The proposal details a ground-based pesticide application targeting Mountain Pine Beetle (Dendroctonus ponderosae) prevention on approximately 100 pre-designated high-value ponderosa pine trees within the campground. The applicant will apply Sevin XLR Plus (EPA registration 264-333, containing 4% carbaryl active ingredient) using high-pressure hydraulic sprayers at a rate of 1 gallon per 50 square feet of bark surface, diluted at 3.9 gallons per 100 gallons of water, resulting in 1.8 lbs active ingredient per tree. A single application is planned for May 2014. The proposal incorporates a 200-foot no-spray buffer along Cold Creek (perennial water body), plastic covering of campground amenities and blackberry shrubs near units 45 and 46, use of certified applicators only, extended personal protective equipment beyond label requirements, a 12-hour re-entry interval, water-sensitive spray cards for drift monitoring with operational suspension protocols, county permitting and reporting, and a 5-day public closure following treatment. The area will be posted 48 hours before spraying and again after application with information regarding the chemical used and reopening timeline. The form includes signature blocks for the Pesticide Use Coordinator and approving official but these remain unsigned on this example form.
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File Code: 2100 Page 1 of 3For technical questions and Section 508 accommodation, please contact
Pesticide-Use Proposal
FS-2100-0002 (REV.02/2019)
OMB 0596-0241 Exp. 2/28/2022(Reference FSM 2150)
To complete this form, see instructions for Form FS-2100-0002, Pesticide-Use Proposal
Agency / Cooperator*
USDA Forest Service
Contact Name, Phone Number and e-mail*
Smokey Bear, (555) 555-5555, sbear@fs.fed.us
Region*
R7
Forest/District*
Canoe NF/ Big Lake RD
Date Submitted*
2/14/19
How would you like to be informed of the decision on your proposal?* Telephone E-mail Both
1) OBJECTIVE a) Smokey Campground Bark Beetle Prevention
a) Project name and/or identifier
b) Specific target pests(s) b) Mountain Pine Beetle (Dendroctonus ponderosae)
c) Purpose c) Prevention of successful beetle attack
2) PESTICIDE PRODUCT(S) a) Sevin XLR Plus
a) Trade name
b) Formulation as purchased b) Liquid
c) Restricted-use Pesticide(yes/no) c) Nod) EPA registration number
e) Common name of chemical(s) d) 264-333
f) AI, AE, IU, or PIB expressed as % or concentration e) Carbaryl
f) 4 lbs a.i. per gallon
3) TYPE OF APPLICATION a) Ground-based
a) Method
b) Equipment b) High-pressure hydraulic sprayer
4) FIELD APPLICATION INFORMATION a) spray
a) Formulation of material to be applied b) 1 gallon per 50 square feet of bark surface
b) Planned application rate
c) Dilution rate c) 3.9 gallons/100 gallons or 5 oz/1 gallon
d) Diluent
e) Pounds of AI or AE per acre(or other d) Water applicable rate)
f) Other pesticides being applied to e) 1.8 lbs a.i. per tree proposed treatment site(s)
f) None
5) TREATMENT AREA DESCRIPTION a) Pre-designated high value trees in campground, unless they have current evidence of bark
a) Targeted treatment area beetle attack
b) State and County
b) Montana, Missoula Countyc) Site Description
d) Estimate of acres(or other unit) to c) Campground within a ponderosa pine-dominated forest, level ground, Cold Creek (perennial) be treated flows along north end of campground.
e) Number of applications
f) Month(s) and year(s) of application d) 100 trees
e) 1
f) May 2014
6) SENSITIVE AREAS a) None
a) Special designated area (if
b) Cold Creek, 200 foot no-spray bufferapplicable)
b) Areas to be avoided c) Cover with plastic all camp tables, barbeques, firepits, faucets, toilets. Remove plastic once
c) Areas to be treated with caution residues have dried. Cover blackberry shrubs near units 45 and 46 with plastic as well.
Example fseforms@fs.fed.us
File Code: 2100 Page 2 of 3For technical questions and Section 508 accommodation, please contact fseforms@fs.fed.us
FS-2100-0002 (REV.02/2019)
OMB 0596-0241 Exp. 2/28/2022
7) PROJECT IMPLEMENTATION
a) Trained/certified personnel to be used
b) Personal safety
c) State and local coordination
d) Best management practices
e) Monitoring
f) Additional project information
a) Certified applicators only
b) In addition to label-required PPE, applicators will also wear chemical-resistant outerwear, chemical-resistant boots. REI is 12 hours.
c) Obtain county permit prior to application; report use to county after application.
d) Stream buffer along Cold Creek, 200 feet
e) Water sensitive spray cards will be deployed during spray application to delimit the area of drift in stream buffer. Operations will be suspended if drift reaches spray cards and at that point an evaluation will be made until conditions to spray are in the parameters set for this project.
f) The area will be closed to public use during the spraying operation for safety reasons, and to provide the best access for contractors and Forest Service inspectors. The area will remain closed to public access for 5 days following treatment for an added measure of safety. The area will be clearly posted 48 hours before spraying. After spraying is completed, signs explaining that insecticides have recently been applied, what the chemical is, who to contact with questions, and when the area will be opened again will be posted.
File Code: 2100 Page 3 of 3For technical questions and Section 508 accommodation, please contact fseforms@fs.fed.us
FS-2100-0002 (REV.06/2018)
OMB 0596-0241 Exp. 12/2018
For Official Use Only
a) Pesticide Use Coordinator
b) Other reviewer(s) (as necessary)
c) Approval (signature of approving official)
Date
Date
Date
Date
Date
Burden Statement
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The Valid OMB control number for this information collection is 0596-0241. The time required to complete this information collection is estimated to average 2 hours per response including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
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USDA is an equal opportunity provider and employer.
8. REVIEWER SIGNATURE(S)
Attach File(s)
Submit by Email
Other reviewer(s) (as necessary)
Other reviewer(s) (as necessary)
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