A02. APPENDIX F- Pre-Use and Post-Use Form.docx
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- Rend Lake Mowing & Grounds Maintenance
- Solicitation number
- W912P923R0012
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APPENDIX F-1
PRE-USE PESTICIDE/HERBICIDE APPLICATION
Contract/Lease/Easement Number __________________________________________
Area of Application ______________________________________________________
Contractor/Lessee/Easement Holder ____________________________________
Address ____________________________________________________________
City ____________________________________________________________
Phone Number ______________________________________________________
Pesticide (Trade Name) ________________________________________________
Active Ingredients ______________________________________________________
Target Pest ____________________________________________________________
Pesticide EPA Registration Number __________________________________________
EPA Classification ______ General Use ______ Restricted Use
Treatment Method:
| Foliar | ______________ |
| Aerial spraying ______________ | |
| Cut surface _____________ | |
| Basal spray _____________ |
Additional Remarks ______________________________________________________ **NOTE: Photocopies of pesticide license and chemical label must be submitted with pre-use application.
| Submitted By: _________________________ | Date: ________________________ | |
| Signature of applicator |
Recommend Approval ______ Recommend Disapproval ______
| _______________________________ | Date: ________________________ |
| Recommending Natural Resource Specialist |
Approved ______ Disapproved ______
| _______________________________ | Date: ________________________ |
| Approving Official |
Reason for disapproval:
APPENDIX F-2
POST-USE PESTICIDE/HERBICIDE REPORT
Contract/Lease/Easement Number __________________________________________
Area of Application ______________________________________________________
Contractor/Lessee/Easement Holder ____________________________________
Address ____________________________________________________________
City ____________________________________________________________
Phone Number ______________________________________________________
Pesticide (Trade Name) ________________________________________________
Active Ingredients ______________________________________________________
Target Pest ____________________________________________________________
Pesticide EPA Registration Number __________________________________________
EPA Classification ______ General Use ______ Restricted Use
AMOUNT APPLIED __________________________________________
Number of acres applied on ________________________
Additional Remarks ______________________________________________________
Applicator license number ___________________________
Licence expiration date ___________________________
Licence type ______________________
Signature of applicator Date
Signature of lessee Date
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