A02. Appendix I Pre-Use and Post-Use Form.docx
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- Attached to
- Rend Lake Cleaning/Janitorial Services
- Solicitation number
- W912P922R0007
About this file
This document contains a solicitation for cleaning and janitorial services at the Rend Lake Project Office. The U.S. Army Corps of Engineers is seeking these services for their office located at 11981 Rend City Road in Benton, Illinois. Questions regarding the solicitation are due by January 7th, and proposals must be electronically submitted by January 12th. A site visit will be held on January 5th for interested offerors to tour the facility. Proposals should be emailed to the contract specialist Kelsey Daniels at the provided email address and must be in PDF format. The solicitation also provides details on how to request a DoD SAFE link to upload proposal files that are too large to email. Offerors must be registered in the System for Award Management to be considered for award.
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Text version
APPENDIX I-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 I-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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