A00810-608460.pdf

PDF 871 KB Posted

Attached to
608460 HADLEY FAP No. NHP(BRR-ON)-003S(813)X Bridge Replacement, H-01-005, Bay Road (Route 47) ove
Solicitation number
BD-25-1030-0H100-0H002-116001
Issued by
Hampshire County, Massachusetts

About this file

The document is a MassDOT (Massachusetts Department of Transportation) Herbicide Use Report form for the Highway Division, associated with Proposal No. 608460-130088. The form is designed to track and report herbicide applications, requiring detailed documentation of herbicide products used, application methods, targeted weeds, treatment areas, and applicator information. It provides space to record multiple herbicide products, their EPA registration numbers, active ingredient percentages, and formulation details, with a specific note to highlight invasive species like MAM, Hogweed, Pepperweed, Kudzu, and Tree of Heaven.

The form instructs contractors to submit the completed report to the MassDOT District Engineer and Landscape Design Section in Boston upon completion, with a particular emphasis on tracking treatments related to invasive species. It includes provisions for noting the contractor performing the work, project location (towns and routes), project description, treatment description, weeds targeted, application method, area treated (in acres, square yards, or miles), gallons of formula used, and start and end dates/times. The form also requires applicators to list their license numbers and provides a space for additional product information such as surfactants.

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Text version

Massachusetts Department Of Transportation Highway Division

A00810 - 1

DOCUMENT A00810

MassDOT Herbicide Use Report

Proposal No. 608460-130088

07/18/2018

Use multiple sheets for multiple application techniques or sites as needed.

Product Used:

Upon completion, please submit form to MassDOT District Engineer and Landscape Design Section in Boston office.

MassDOT Herbicide Use Report Date Submitted:

Name: _____________________

EPA Reg. No: _______________

% Active Ingredient

Dry: ___________________

Liquid: _________________

Formulation (dilution rate): _______________

Name: ______________________

EPA Reg. No: _______________

% Active Ingredient

Dry: ____________________

Liquid: _________________

Formulation (dilution rate): _______________

Name: _____________________

EPA Reg. No: _______________

% Active Ingredient

Dry: ___________________

Liquid: _________________

Formulation (dilution rate): _______________

Additional products used (surfactants, etc.) or other information:

Applicators: License Numbers:

* Please note:

EDRR Species (MAM, Hogweed, Pepperweed, Kudzu, etc.)

Tree of Heaven 1) stands of >20 trees; 2) >5 trees near nursery, landscape company, or highway rest area where trucks stop

Contractor Performing Work:

Town/s:

Project or Contract No:

Associated Route:

Project Description:

Treatment Description:

Weeds Targeted:

Application Method:

Acres:

Gallons Formula Used:

Date/Time Began:

Date/Time End:

Area Treated (as applicable)

Sq Yds: Miles:

MDAR ALERT*:

A00810 - 2

Proposal No. 608460-130088

File details come from the government source that posted it. Updated .