Revised_PWS_Amendment_1_16_July_24_0002.pdf

Performance Work Statement (PWS)

Montour Wildlife Management Area Weed

Treatment Services

June 6, 2024

Amendment 1: July 16, 2024

C.1 Introduction

C.2 Mission

C.3 Scope

C.4 Non-Personal Services

C.5 Business Relations

C.6 Contract Management and Administration

C.6.1 Contract Management

C.6.2 Contract Administration

C.7 Personnel Administration

C.8 Contractor Qualifications, Personnel, Disciplines, and Specialties

C.9 Location and Hours of Work

C.10 Period of Performance

C.11 Specific Tasks

C.12 Applicable Publications and Forms

C.13 Special Requirements

C.14 Safety/Regulations/Policies

C.15 Quality Control

C.16 Invoicing/ Payment

C.17 Performance Requirements Summary (PRS)

C.18 Reports or Data Deliverables

C.19 Exhibits

Performance Work Statement (PWS)

Montour Wildlife Management Area Treatment Services

C.1 Introduction

Federal legislation including the Federal Insecticide, Fungicide, and Rodenticide Act of 1947 (as amended);

the Carson-Foley Act of 1968; the Federal Noxious Weed Act of 1974 (as amended), and the Plant Protection

Act of 2000, authorize and direct Reclamation to implement weed management as well as to coordinate with

Federal, State, and local agencies on the management of noxious weeds and invasive plants. The Idaho

Department of Fish and Game (IDFG), through an agreement with the Bureau of Reclamation, manages

Federal land surrounding the Montour Wildlife Management Area (WMA) in Gem County, Idaho. Montour

WMA consists of 1,000 treatable acres. The contractor shall be responsible for treating a minimum of 125 acres per year. See Exhibit A – Location Maps. Reclamation uses an integrated pest management approach to control noxious weeds and invasive plants, which to date includes chemical and mechanical methods of control on the lands it administers at Montour WMA. Mapping is an important component of a noxious weed and invasive plant species control program. Mapping indicates the extent and location of an infestation, and when combined with other information about a species including severity and density, constitutes an inventory.

Currently, Reclamation has neither the personnel nor the equipment to successfully conduct noxious weed and invasive plant mapping or treatments for its lands within the Montour WMA.

C.2 Mission

Protect project facilities and provide public safety, through weed management treatments to reduce risk of wildfire and improve habitat in the surrounding area.

C.3 Scope

The purpose of this contract is to secure services for ground-based herbicide spraying The Contractor shall furnish all labor, supervision, equipment, chemicals, tools, materials, supplies, transportation, supervision, and other items and incidentals; and perform all work necessary to complete application in accordance with the specifications in this contract, and the Herbicide Label(s). The contractor shall identify, map, and treat invasive weed species on Reclamation-administered Federal lands within the Montour WMA in Gem County, Idaho. The contractor shall coordinate these activities with Reclamation’s managing partner IDFG.

C.4 Non-Personal Services

The Government shall neither supervise contractor employees nor control the method by which the contractor performs the required tasks. Under no circumstances shall the Government assign tasks to, or prepare work schedules for, individual contractor employees. It shall be the responsibility of the Contractor to manage its employees and to guard against any actions that are of the nature of personal services or give the perception of personal services. If the contractor believes that any actions constitute, or are perceived to constitute personal services, it shall be the contractor's responsibility to notify the Contracting Officer (CO) immediately.

C.5 Business Relations

The contractor shall successfully integrate and coordinate all activity needed to execute the requirement. The contractor shall manage the timeliness, completeness, and quality of problem identification. The contractor shall provide corrective action plans, proposal submittals, timely identification of issues, and effective management of subcontractors. The contractor shall seek to ensure customer satisfaction and professional and ethical behavior of all contractor personnel.

C.6 Contract Management and Administration

The following subsections specify requirements for contract, management, and personnel administration.

C.6.1 Contract Management

The contractor shall establish clear organizational lines of authority and responsibility to ensure effective management of the resources assigned to the requirement. The contractor must maintain continuity between their support operations, IDFG and Reclamation’s Natural Resource Specialist (NRS).

C.6.2 Contract Administration

The contractor shall establish processes and assign appropriate resources to effectively administer the requirement. The contractor shall respond to Government requests for contractual actions in a timely fashion.

The contractor shall have a single point of contact between the Government and contractor personnel assigned to support contracts. The contractor shall assign work effort and maintaining proper and accurate time keeping records of personnel assigned to work on this requirement.

C.7 Personnel Administration

The contractor shall provide the following management and support as required. The contractor shall provide for employees during designated Government non-workdays or other periods where Government offices are closed due to weather or law enforcement conditions. The contractor shall maintain the currency of their employees by providing initial and refresher training as required to meet the PWS requirements. The contractor shall make necessary travel arrangements for employees. The contractor shall provide necessary infrastructure to support contract tasks.

C.8 Contractor Qualifications, Personnel, Disciplines, and Specialties

The contractor shall possess applicable permits, certifications, and licenses (i.e., Business Permits, CDL endorsement, Applicator’s License, etc.) to complete services in accordance with this PWS as required by

Federal, State and Local regulations. The contractor will ensure all documents are kept current. The contractor shall accomplish the assigned work by employing and utilizing qualified personnel with appropriate combinations of education, training, and experience. The Contractor shall provide the necessary resources and infrastructure to manage, perform, and administer the contract as shown in the Performance Requirements

Summary Table.

Deliverable:

A01 - Business Certificates

The contractor shall be required to supply Reclamation with the legal names and other personal information of employees who will be working under this contract.

A02 - Employee Names

C.9 Location and Hours of Work

Accomplishment of the results contained in this PWS requires work at Reclamation lands within the Montour

WMA. Treatment must take place Monday- Friday and coordinated with IDFG for site access. Portions of the

Montour WMA are closed from February 1 through July 31, see Exhibit A, Figure 3. Any treatment during this time must be coordinated with IDFG and the Contracting Officer’s Representative (COR).

The applications will coincide with invasive species phenology (typically spring and fall treatments with scattered summer treatments). Initial target weed control areas will be coordinated and identified annually with

IDFG Regional Habitat Biologist and documented within a pesticide-use proposal (PUP). This information is required by Reclamation before application of a pesticide on Reclamation property. It is a protective measure to ensure the proper use of pesticides on Reclamation lands and is provided by the contractor. The PUP should include where the pesticide is applied, what pesticide is used, what species will be managed and ensure that pesticide labels are read, and pesticides are used safely and effectively to eliminate and reduce unnecessary use

(See link to Bureau of Land Management PUP in Section C.12).

A03 - PUP

C.10 Period of Performance

The period of performance is for one (1) Base Year and four (4) option years.

C.11 Specific Tasks

Task 1 – Noxious Weed and Invasive Plant Control:

a. Conduct field surveys during the treatment of target weed areas and identify specific locations in which weeds have become established or are invading and treat accordingly. This shall be presented in the

PUP provided by the contractor. Consult with IDFG Regional Habitat Biologist and Reclamation’s

Technical Representative (TR) for determination and/or coordination of priority areas and treat identified high priority areas. The contractor shall be responsible for covering/surveying within the

1,000 acres but may only treat a minimum of 125 acres per year.

b. Work with any Federal, State, or local governmental or public interest entity involved in the application, gathering, and dissemination of biological control (Biocontrol) agents, obtaining them for use on Reclamation-administered Federal land.

Biocontrol is the application of one living organism to control another: also referred to as a biological pest control. The biological application is mainly introduced to reduce the population of a pest and to produce pest free yields. It is a self-sustaining and long-term treatment method, for managing invasive plants and pests. The living organism applied in this system is used to suppress a weed infestation and may include insects, pathogens, and grazing animals.

c. Chemicals:

https://hicare.in/blog/different-types-biological-pest-control-agents/ https://hicare.in/blog/different-types-biological-pest-control-agents/

• The Contractor will supply all the chemicals necessary to complete the specifications of this contract. Only herbicides for use on Reclamation lands and appropriate for the application site type are acceptable.

• Water used for mixing chemicals will may be provided within the WMA at the RV Dump Station in the campground and at the ditch near the junction of McConnel Lane and Montour Main St. as IDFG holds a water right within this ditch. All water used for applications shall be clean and free of particulates that may reduce the effectiveness of herbicides (i.e., cloudy/murky water). The contractor shall use a developed (i.e., standpipe) water source. Natural water sources (i.e., stream or reservoir) may be considered for use if a developed water source is not readily available and if the act of using the natural water source does not negatively impact the resource, as determined by IDFG/COR. All natural water sources must be approved by the IDFG/COR prior to use. It is the Contractor’s responsibility to identify, locate, and contact landowners to ensure water-right permissions are followed.

• Contractor shall adhere to the chemical herbicide application rates for selected species as listed on the container product labels.

• Adjuvants:

o Contractor shall adhere to surfactant rates listed on the container label and the Surfactants should be included in the quote description and price.

o Drift agents may be used. Controlling drift is the responsibility of the Contractor. If a drift control additive is used, the Contractor shall read and carefully observe the cautionary statements and all other information appearing on the additive label. If a drift agent will be used, it should be included in the quote description and price.

o The use of colorant/indicator dye is required. Dye must be visible for 3 days after application.

Dye should be included in the quote description and price.

o All adjuvants shall be handled as chemicals.

• Dust Abatement - Any material used for dust abatement, other than water, shall be approved by the COR prior to use.

d. Equipment:

• General - The Contractor shall furnish properly outfitted equipment with applicators experienced in applying herbicides in rough terrain. The Contractor shall service and repair their equipment as necessary to maintain satisfactory progress on work. Contractor is responsible for all costs incidental to equipment move-in and move-out associated with the project.

• The Contractor shall furnish sufficient equipment to satisfactorily spray the designated areas in the time specified as required in this PWS. Equipment shall be capable of traveling at moderate speed to give proper control and even distribution of herbicide. Contractor shall furnish all fuel, oil, and service required for operation of equipment and vehicles.

• Base of Operations - The Contractor shall provide such staging/loading facilities as may be required for competent performance of contract. Use of any loading area shall be arranged by and at the discretion and risk of the Contractor, and the Government shall not be held responsible for any loss, mishap, or accident due to conditions of any loading facility used. Any applicable fees for loading facilities are the responsibility of the Contractor.

• Spray Tanks - Spray solutions of the product shall be mixed, stored, and applied using only stainless steel, aluminum, fiberglass, plastic, or plastic-lined steel containers.

• Spray Nozzles - Contractor shall furnish a nozzle type that is designated for the intended application.

Refer to the herbicide label for proper nozzles to comply with. Spray drift management: The interaction of many equipment and weather-related factors determines the potential for spray drift. The

Contractor is responsible for considering all these factors when making application decisions.

Avoiding spray drift is the responsibility of the Contractor.

• Booms - Contractor shall furnish non-rust booms.

e. Work Crew:

• An Idaho Licensed Applicator - Shall be furnished by the Contractor and must be present on-site during all mixing, handling, and application of herbicides.

• Work crew - Shall be furnished by the Contractor for handling and mixing the herbicide and loading the equipment. The Contractor shall furnish the necessary qualified mechanics for maintenance of equipment at the project site and/or services for repair off-site.

f. Execution of Work:

• Pre-Work Conference - Prior to commencement of work, a meeting will be requested by the Contracting

Officer to be attended by the Contractor, the COR and IDFG Representative. The meeting will be held onsite at a time mutually agreeable to the Contractor and the Contracting Officer to discuss the work schedule and to familiarize both parties with the responsibilities of each under this contract. At this time a work schedule showing dates, locations, equipment, and employees working on this project shall be provided by the Contractor to the Contracting Officer.

• Work stoppages - The Contractor agrees to work diligently to complete the application of the herbicide.

Partial workdays will be counted as full days of performance time.

• Termination for convenience of the Government - Because of the nature of the work, the Contracting

Officer may, by written notice to the Contractor, terminate this contract, in whole or in part, when it is in the best interest of the Government. To the extent that this contract is so terminated, the Government shall be liable only for payment in accordance with the payment provisions of this contract for work satisfactorily completed prior to the effective date of termination.

• Risk damages - The Contractor shall assume all risks in connection with performance of the contract and shall be liable for any damages to persons or property in connection with the prosecution of the work, including the applicator or other employees of the Contractor.

g. Environmental Conditions:

• Work Period - Spraying Operations will be permitted only during daylight hours. The Contractor will have personnel on project site prior to commencing daily application, during application, and will notify

COR or IDFG of changing weather conditions. The COR or IDFG will allow Contractor to continue or stop application if weather factors dictate.

• Wind - The Contractor shall follow the herbicide labels and spray drift management. Local wind can influence wind patterns. Every applicator should be familiar with local wind patterns and how they affect drift. All applications must cease if winds are gusty and/or exceed 10 mph for ground-based applications. Measurements shall be collected on-site of active herbicide application.

• Relative Humidity - Refer to the product label when making applications in low relative humidity conditions. Measurements shall be collected on-site of active herbicide application.

• Precipitation – Contractor is responsible for re-treatment, at Contractor’s expense, if herbicide is washed off due to application when predicted precipitation event was imminent; refer to herbicide label.

• Site Conditions - No herbicide application will be allowed if conditions do not meet federal, state, or label requirements (Most restrictive guidelines shall be followed). During the application within the

WMA there are limited roads so most of the work will be performed with ATV/UTVs, as long as their use does not cause resource damage as determined by the COR (i.e., rutting greater than 4 inches in depth, creation of roads, crushing/trampling of vegetation). Off-road/overland travel with trucks will not be permitted. All equipment, vehicles, trailers, UTVs, and ATVs must be cleaned using a high pressure/power wash and/or compressed air with particular attention given to undercarriage and moving parts prior to on-site arrival and initiation of contract work to the satisfactory level of the COR.

• Cultural Considerations – Because cultural resources may be present in the area, ground-based project activities and any other action that causes disturbance of the ground’s surface shall be limited to those areas approved by the COR/IDFG. If ground equipment is used for herbicide application, deviations from routes flagged, shown on drawings or GPS files are not allowable without prior written approval of the

Contracting Officer. The Contractor shall insure that he, his employees, or his representatives do not collect or disturb historic or prehistoric artifacts in accordance with the Archeological Resources

Protection Act (43 CFR 7). Should the condition of the cultural resources in the area be altered during treatment due to unauthorized activity by the Contractor or his employees, the Contractor shall be responsible for all costs of mitigating the cultural resources involved. If deterioration of the archeological sites is found to be occurring during treatment, work on the project shall be terminated until a data recovery plan is prepared and completed in accordance with the National Historic Preservation Act (36

CFR 800). The contractor shall immediately bring to the attention of the Contracting Officer any and all cultural resources including, but not limited to, historic and prehistoric sites or artifacts, buried artifacts, and buried features such as fire pits, burials, and house floors discovered as a result of treatment operations. The Contractor shall immediately suspend all activities in the immediate vicinity that might harm the object(s), notify the Contracting Officer, and shall leave such discoveries intact until instructed to proceed by the Contracting Officer.

• Wildlife, Plants, and Special Management Areas – For applications made in sensitive habitat for either flora or fauna or areas with special management, additional restrictions may apply. It is the responsibility of the contractor to be able to accurately identify the target species in all phenological stages and to differentiate the target species from native, non-target plant species. Significant herbicide application to non-target species, native plant species (spraying greater than 5% of the given plant population) whether intentional or out of ignorant negligence, will result in suspension of the contract and review by the

CO/IDFG. The review may result in the contractor facing civil and criminal penalties for spraying non-target, native plant species set forth in § 4140.1 Acts prohibited on public lands.

h. Hazardous Materials and Solid Waste:

• If in connection with the operation under this contract, the Contractor, or their employees discover, encounter, or become aware of any hazardous materials or solid waste in the project area, such as closed glass or plastic containers, barrels, household garbage, or chemical spills, the Contractor shall immediately suspend all operation in the vicinity of the hazardous material or solid waste and shall notify the CO of the findings. Operations will resume at the discovery site upon receipt of written instructions. No objects of hazardous material or solid waste shall be removed from the project area.

• Dumping of waste material at any time during the commission of work under this contract on Federal lands, is a violation of Federal law (43CFR 8365.1-1 (b) (1) and (4)). Any refuse, debris, or garbage generated by the Contractor shall be removed daily and disposed of legally off site. Final payment will be withheld until all refuse, debris, or garbage generated by the Contractor is removed.

Task 2 – Completion of Document:

a. Applicator Records

• Pesticide Application Record (PAR): For all pesticide applications the Contractor must fill out a

PAR within 2 working days of application of treated sites, (this decreases forgetfulness and poor record keeping if it lags beyond 2 days). Final PARs shall be turned in and reviewed by the COR within one (1) week after end of each option period and must be furnished upon request during field visits. All fields on the PAR form shall be completed. At a minimum a separate PAR shall be filled out for each day of treatment or site type/tank mixture (i.e., terrestrial versus aquatic/riparian site).

More than one species may be included on the same PAR if they are treated in the same location with the same pesticide. PAR must have all of the information in the attached template (Exhibit B), but any layout/format (pdf, word, excel may be used). Refer to C.12 Publication and Forms and

C.19 Exhibits.

b. Global Positioning System (GPS) Tracklogs:

• Contractor must document, by use of a GPS, geographic tracklogs of spray activities. Tracklogs must be completed on the day of application, and electronically submitted via email to the COR quarterly in an ESRI ArcMap compatible format.

• The Contractor provided GPS device(s) must be capable of continuously logging data at a minimum of two second time intervals and have a minimum interval distance threshold of seven feet. The tracks must be recorded with a horizontal accuracy of 27 feet minimum and a vertical accuracy of

20 feet minimum. To be considered complete, each tracklog record will include: the contract name, x,y position coordinates, tracklog date, track start time, and track end time.

c. Broadcast Application Tracklog:

• This type of tracklog is typical of contract areas in which an area needs to be sprayed in its entirety with continuous coverage (i.e., Bare ground treatment or annual grass control).

d. Spot Application Tracklog:

• This type of tracklog is typical of contract areas in which weeds are scattered throughout the area in various locations and varying densities and herbicide application is not continuous. This type of tracklog requires all applicators provide a tracklog (to show application pathway and document coverage of the contract area).

IDFG/COR will conduct periodic surveillance, random inspections, and review of the treated areas, taking photographs, collecting GPS data, and estimating control success (percentages). These actions will determine both adequacy of coverage and rate of detection of noxious weed and invasive plant occurrences. A determination of successful execution of this purchase order shall be based on the IDFG/COR inspections of the treatment areas, as shown in the Performance Requirements

Summary Table (below).

If results of these actions determine that work to date has not met or exceeded the accepted quality level, the IDFG/COR shall meet with the contractor on-site to discuss the deficiencies.

The contractor shall correct the deficiencies by treating the sites that were missed and/or re-treat areas where the treatment was inadequate. If the area is re-treated, it will be at no additional cost to the

Government. If follow-up inspections determine that the acceptable treatment levels have not been met after re-treatment, the contractor, shall re-treat until an acceptable level is reached as determined by the

CO at no additional cost to the Government.

A04 - Professional Applicators Pesticide Application Records & Annual Progress Reports

C.12 Applicable Publications and Forms

• PUP Sample: BLM PUP Form Final.pdf

• Pesticide Licensing and Application Records Pesticide Applicator Licensing & Certification | Idaho

State Department of Agriculture

• PAR Example: See Exhibit B

C.13 Special Requirements

The contractor shall perform the clerical duties necessary for providing copies of the logs from work completed and the annual reports of work performed.

C.14 Safety/Regulations/Policies

All equipment and operations shall adhere to Reclamation Safety and Health Standards (RSHS), 2009 Edition

Safety | Bureau of Reclamation (usbr.gov) and 29 CFR 1910, Safety and Health Regulations for General

Industry 1910 | Occupational Safety and Health Administration (osha.gov).

All chemicals used shall be in accordance with the current registration, label direction, or other directives regulating their use (Idaho State Department of Agriculture, OSHA, etc.) and must be safe for use around and close to aquatic areas. The Contractor shall comply with all Federal, State and Local operational requirements, and licensing requirements as may be pertinent to the required commercial application of chemicals, pesticides and herbicides.

C.15 Quality Control

The Contractor shall develop a Quality Control Plan (QCP) and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services.

The Contractor’s QCP is the means which they assure themselves that their work complies with the requirements of the contract.

The finalized QCP will be accepted by the Government at the time of the award of the Contract. The

Contracting Officer may notify the Contractor of required modifications to the plan during the period of performance.

The Contractor shall coordinate suggested modifications and obtain acceptance of the plan by the Contracting

Officer. Any modifications to the program during the period of performance shall be provided to the

Contracting Officer for review no later than 10 working days prior to the effective date of the change. The QCP shall be subject to the Governments review and approval. The Government may find the QCP “unacceptable” whenever the Contractors procedures do not accomplish quality control objective(s). The Contractor shall revise the QCP within 5 working days from receipt of notice that QCP is found “unacceptable.”

Deliverable:

A05- Quality Control Plan

../../../../../../../../GFitzgerald/Downloads/https/www.fs.fedus/foresthealth/pesticide/pdfs/FS-2100-0002_Form.pdf https://www.blm.gov/sites/default/files/documents/files/BLM%20PUP%20Form%20Final.pdf https://agri.idaho.gov/pesticides/applicator-licensing-certification/ https://agri.idaho.gov/pesticides/applicator-licensing-certification/ https://www.usbr.gov/safety/rshs/index.html https://www.osha.gov/laws-regs/regulations/standardnumber/1910

C.16 Invoicing/ Payment

Payment will be the actual area, in acres, that is satisfactorily treated within the designated boundaries in conformance with this PWS, minimum of 125 acres per year. Measurement be based on the information provided by the Contractor and verified by the Government. Invoices shall be submitted monthly when treatment occurs.

C.17 Performance Requirements Summary (PRS)

Performan ce

Requirem ent

Performance

Indicator

Acceptable

Quality

Level

Method of

Surveillance

Remedy for

Non-performance

Task 1 –

Noxious Weed and Invasive

Plant Control

Percentage of priority areas treated with identified preferred methods as stated within the PUP

90%

Periodic

Surveillance;

Random

Sampling

For any detected noxious weeds, Contractor shall re-treat within two weeks of notification at no additional cost to the

Government. Failure to do so may result in termination of the purchase order or delay in payment.

Task 2 –

Completion of

Documentation including PUP, Progress report and submission of PAR and associated maps

(attached).

Provide a copy of PUP prior to implementatio n of work.

Provide

Progress report and submission of

PAR and associated maps.

90%

Documentatio n Review, and on-site visual inspection

For any missed records that are not submitted on time, Contractor shall have one (1) additional working day to furnish documentation without delay in payment.

C.18 Reports or Data Deliverables

Deliverables

The Contractor shall provide deliverables as described in this PWS to the TR/COR.

Number Name Frequency Quantity

A01 Business Certificates Prior to 1 electronic

All applicable permits, certifications and licenses required by Federal, State and Local regulations. Documents.

commencing work and within one (1) week after receiving updated or renewed documents.

copy

A02 Employee Names Prior to commencing work and for each new employee.

1 electronic copy

A03 Pesticide Use Proposal (PUP) - identify specific locations in which weeds have become established or are invading

Provide a Treatment Schedule to the COR

One week prior to start of contract performance period.

1 electronic copy

A04 Professional Applicators Pesticide

Application Records & Annual Progress

Reports, including maps

Within two

(2) working days after any application & within one (1) week after end of each option period.

1 electronic copy

A05 Quality Control Plan (Government has 10 business days to review and approve.

Contractor has 5 business days to correct any deficiencies noted by Government)

Prior to commencing work

1 electronic copy

C.19 Exhibits

A. Location Maps-

Figure 1. Bureau of Reclamation -Montour WMA Administered Federal Land Located Within Gem

County, Idaho that shall be treated for noxious weeds and invasive plants.

Figure 2. Directions from Boise, ID to Montour WMA Administered Federal Land.

Figure 3. Site Visit Meeting Location, parking lot circled in blue.

B. BLM PAR Template (Sample)

Pesticide Applicator Record Treatment Record ID _____________

LOCATION INFORMATION

BLM Project Name

Exact Location of Treatment Site:

(ex:38.468218, -108.101364)

State:

County:

BLM Field Office:

TREATMENT INFORMATION

Treatment

Date (ex: 6/1/2014)

Treatment Start Time (ex: 0800)

End Time

(ex: 1600)

Temperature (F) Wind Speed /

Direction

Humidity

BLM PUP #

(ex: WYP070-14-003-P)

Equipment Used (circle one)

TRUCK – ATV – UTV - BACKPACK – AIRPLANE - HELICOPTER –

HANDHELD SPRAYER – WICK/WIPER – MOWER – TRACTOR –

HORSEBACK SPRAYER

Applicator Name

/license #/Role

(ex: John Doe/14-001/

Applicator)

Mix Diluent

(circle one) WATER – OIL - NONE

Sprayer Calibration

Rate

(ex: 2 GALLONS/ACRE) (circle appropriate Rate)

GALLONS/ACRE

OUNCES/ACRE

PINTS/ACRE

POUNDS/ACRE

QUARTS/ACRE

Distance to Water (circle one)

0 TO 10 FEET - 10 TO 25 FEET

25 TO 100 FEET - GT 100 FEET

Delivery Method

(circle one)

AERIAL - GROUND

Spray Pattern

(circle one)

BROADCAST - SPOT

Total Acres

Treated (ex. 200)

FOR SPOT APPLICATIONS ONLY

Mix Amount Applied on Site (ex: 2 GALLONS) GALLONS

CHEMICAL BRAND(s) APPLIED - In formulated product units

CHEMICAL TRADE

NAME (ex: Roundup

Pro, Overdrive)

MANUFACTURER

(ex: MONSANTO, BASF)

EPA REG #

(ex: 524-475, 7969-150)

CHEMICAL

COMMON NAME

(ex: Glyphosate, Dicamba +

Diflufenzopyr)

RATE OF APPLICATION

Liquid ex: 2 QUARTS PER ACRE, , 8 FLUID OUNCES PER

ACRE, 1 PERCENT SOLUTION

Dry ex: 0.50 POUND PER ACRE, 1 OUNCE PER ACRE

ADJUVANTS BRAND(s) APPLIED - In formulated product units

ADJUVANT

BRAND NAME

(ex: DYNE_AMIC)

MANUF

(ex: HELENA

CHEMICAL)

RATE OF APPLICATION

Liquid ex: 2 QUARTS PER ACRE, , 8 FLUID OUNCES PER ACRE, 1 PERCENT SOLUTION

Dry ex: 0.50 POUND PER ACRE, 1 OUNCE PER ACRE

SPECIES INFORMATION

SPECIES CODE

(ex: ACRE3)

SPECIES COMMON

NAME

(ex. Russian Knapweed)

PLANT PHENOLOGY

(circle one)

ESTIMATED PERCENT COVER (circle one)

BARE GROUND – BOLT – BUD –

DORMANT – FLOWER – MATURE

– PRE-BUD – ROSETTE – SEED SET

– SCENESCENT - VEGETATIVE

Trace (Less than 1%) – Low (1-5%) – Medium (5-25%) -

High (25-100%)

BARE GROUND – BOLT – BUD –

DORMANT – FLOWER – MATURE

BARE GROUND – BOLT – BUD –

DORMANT – FLOWER – MATURE

***If more species treated, attach another form and record there.