A02. APPENDIX F- Pre-Use and Post-Use Form.docx
DOCX document 14 KB Posted
- Attached to
- Rend Lake Mowing & Grounds Maintenance Federal contract opportunity
- Solicitation number
- W912P923R0012
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| A21. AMENDMENT - SOLICITATION 16 MARCH.pdf | ||
| QUESTIONS - ANSWERS -W912P923R0012 .docx | DOCX document | |
| A21. SOLICITATION - Updated 7 MAR.pdf | ||
| A21. SOLICITATION 16 FEB - UPDATED SITE VISIT DATE.pdf | ||
| A02. APPENDIX A- Rend Lake Area -Campground maps.pdf | ||
| A02. APPENDIX E- SAMPLE SCHEDULE.pdf | ||
| APPENDIX H- Accident Prevention Plan EM385-1-1 .pdf | ||
| A02. Appendix D - QASP.docx | DOCX document | |
| A21. SOLICITATION 16 FEB.pdf | ||
| A02. APPENDIX B- Maps-UPDATED.pdf | ||
| Appendix I - Definitions.docx | DOCX document | |
| A02. APPENDIX C -Vehicle Signs (1).pdf | ||
| Appendix G - Deliverables Schedule.docx | DOCX document |
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Text version
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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