Attachment_C_-_NNIP_Treatment_Form.docx

Entered in TESP-IS Date:

INVASIVE PLANT TREATMENT FORM -- HIAWATHA NATIONAL FOREST

Treatment - General Information Attach Invasive Plants survey form and map of treatment area if applicable

Project / Site Name_________________________________________________ (e.g. East Gravel Pit) Contract Line Item: ____________ FS District: ______________ County name: ________________ GPS Coordinates:__________________________________________________________________ Target Species Code: ____________________ Species Common Name: (multiple target species can be recorded)_________________________________________________________________________ ________________________________________________________________________________ Phenology at time of treatment:______ Pre-emergent (P), Pre-flowering (PF), Flowering (F), Fruiting (FRT), Senescent (S)

Treatment type code: _______ Manual (M), Mechanical (MM), Biocontrol (BA), Fire (F), Chemical (C) Type of Equipment Used____________________________________________________________ Treatment Start Date/Time: ______________ Stop Date/Time: _____________________________ Total Treatment Hrs: ______________________________(list hrs/day if treatment occurred multiple days)

Acres Treated: _______________________ (if linear = miles of 2-sided road x 3.63)

Narrative of treatment (equipment used if applicable; describe location; type of site: pit, roadside, riparian, etc.) _________________________________________________________________________________ List TES plants if present (COR completes) ______________________________________________

Database Information (contractors leave blank)

NRIS Site ID (or use “non-Terra inventory” if not mapped)_______________________________________ FACTS Activity Unit ID ________________________(e.g NNIS200703) Use NNIS, year, district code FACTS Treatment Subunit ID _________________ (3 digits, starting at 001 for the year) FACTS Subunit Name _________________________________________(may be same as Project Name) Fund code __________________________ Cost/Unit of measure _____________________________

Chemical Treatment Information

Certified Pesticide Applicator’s name:___________________________________________ Applicator(s) name (if different than above): _______________________________________ Contractor company name: __________________________________________________

Temperature ______ Wind speed ______(mph) Wind direction ______ Cloud Cover % ________________ Distance to water (if applicable) __________

Start time_____________ Stop time_____________ Chemical Product name________________________ Dilutant used (circle): WATER OIL OTHER Active Ingredient name_________________________ Colorant? YES NO

Application Rate: Percent solution is recommended from the label and is usually figured by ounce per gallon Percent % solution _____________ OR Product Rate (oz/acre; lbs/acre; or pt/acre):_______________

Adjuvant / Surfactant used _____________% solution Total Volume of mix applied _____________ (gallons, liters, or pounds)

Biological Treatment

Need to fill out separate Biocontrol release form with specifics on agents released and location.

Treatment Monitoring Results: on back >>>>>>>>>>>>>>

INVASIVE PLANT TREATMENT MONITORING

Note: 50% of all treatments must be monitored in the current year Use this form for entering treatment effectiveness monitoring in FACTS database.

Date of monitoring: _____________________________

Project / Site Name: __________________________________________________________

Inspector Name: _____________________________________________________________

Species Monitored: ___________________________________________________________

Effectiveness of treatment on target population (see codes below): _____________________

Additional Treatment Completed (at time of monitoring): ________________________________

Comments: ________________________________________________________________________

% Cover of remaining target species (optional) _________ Count of individuals (optional) ___________

Density-how big is the population now? (optional) ________________ (sq.ft / sq.meter / acre)

Distribution (optional) ___ Continuous / Isolated / Linear / None / Patchy / Scattered / Scattered-Patchy

Other Notes: ________________________________________________________________________

Effectiveness Codes

Form modified 05/16/18, DLP