A.02.11 Attach 3 - Pest Control Anticipated Application Record.pdf

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PEST CONTROL ANTICIPATED APPLICATION RECORD - Operations

ATTENTION: This record must be completed prior to January 1st, and a separate record completed for each pest control category or change in formulation. It must be forwarded electronically via email to the assigned Corps of Engineers Pest Manager.

Page of NWW Form 1000-O, Jan. 2023 Page of NWW Form 1000-O, Jan. 2023

1. Pesticide Application Sponsor Trade Name Active Ingredient (AI) Pounds of AI Biological Control Mechanical Control National Historic Preservation Act/Cultural (Section 106) Compliance Completed? (*See APMP instructions) Manual Control National Historic Preservation Act/Cultural (Section 106) Compliance Completed? (*See APMP instructions)

3. Target Species Pest Category Pest Name

INSTRUCTIONS

Pest Control Anticipated Application Record Notes:

- Fields with an asterisk (*) are mandatory.

- Selecting 'Other' in any field requires supplemental information in the Comments field.

- The 'Reset all but Applicator Data' button may be used to clear the record while preserving applicator information.

- The 'Email Data' button may be used to return record data to the assigned Corps of Engineers Pest Manager.

1. Pesticide Application Sponsor: Include contact information for the entity sponsoring the application.

- For "Telephone", enter ten digits without any special characters (,),-, etc.

2. Pest Control Category:

Chemical Control (if applicable): Use the 'Add Row' and 'Delete Row' buttons as required to describe all chemicals including adjuvants (buffer, spreader, sticker, surfactant, etc.) to be used in the year. The trade name is found on the pesticide label.

Biological, Mechanical, Manual Control (if applicable): select the control(s) used.

3. Target Species: Describe the pest that is being controlled.

PRIVACY ACT STATEMENT

AUTHORITY: Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a), and applicable regulations. Engineer Regulation 1130-2-540, Chapter 3 (Pest Control Program for Civil Works Projects).

PRINCIPLE PURPOSE(S): Collection of required data on actual and anticipated use of pesticides on federal lands managed by the U.S. Army Corps of Engineers, Walla Walla District.

ROUTINE USES: The privacy information on this form will be used only by the Walla Walla District of the U.S. Army Corps of Engineers and authorized staff. Such information is protected by the Privacy Act of 1974 and will not be released without the reporting party's consent.

DISCLOSURE: Voluntary; however, failure to provide personal information may not comply with applicable state/local reporting requirements.

8.2.1.4029.1.523496.503679 NWW_pest_mgmt_reports@usace.army.mil USACE NWW District Pest Control Anticipated Application Record