A02_PWS Appendices.pdf

PWS for Land and Vegetative Management Contract

Appendix A: Area Map

Appendix B: Data Requirements

Provide the data as indicated below to the COR. All reports, submittals, logs, and information provided to the Government shall be electronic and compatible with Microsoft Office products.

Item Description Reference Format Frequency

1 Herbicide Usage 1.4 Contractor Format and USACE Form

Original and changes as occurring.

2 Quality Control Plan 2.1 Contractor Format

Original and changes as occurring.

3 Personnel Requirements- Supervision 4.6 Contractor

Format Original and changes as occurring.

4 Limestone 4.5.2 Contractor Format

Original and changes as occurring.

5 Soil Test Analysis 1.13 Contractor Format

Original and changes as occurring.

6 Contractor Points of Contact 4.6 Contractor

Format Original and changes as occurring.

7 Accident Prevention Plan 5.13.3 Contractor Format

Original and changes as occurring.

8 Activity Hazard Analysis 5.13.4 USACE Form Original and changes as occurring.

9 Accident Reports 5.13.6.1

USACE

Accident Report Form 3394

As needed.

Appendix C: Definitions

CONTRACTOR. The “Contractor” is the individual whose contract bid was accepted by the U.S.

Army Corps of Engineers, and who has gained the responsibility of performing the duties governed by the specifications of this contract.

CONTRACTOR REPRESENTATIVE. A foreman or superintendent, assigned to represent the interest of the Contractor with regards to all matters involving this contract.

CONTRACTING OFFICER (KO). The term “Contracting Officer” shall mean the person executing this contract on behalf of the Government, and any other officer or civilian employee who is action on his/her behalf.

CONTRACTING OFFICER’S REPRESENTATIVE (COR). An individual designated in writing by the Contracting Officer to be responsible for administration of the contract and Quality Assurance.

QUALITY CONTROL (QC). The term “Quality Control” refers to action taken by the Contractor and/or personnel to document, inspect, and control performance of services to ensure they meet the specifications and requirements of this contract.

QUALITY ASSURANCE (QA). The term “Quality Assurance” refers to action taken by the Government to ensure the Contractor’s Quality Control System is functioning and effective, and the Contractor is providing services in accordance with this contract. Refer to Appendix C.

CONTRACT DEFICIENCY REPORT (C.D.R.). The Contract Deficiency Report is a written record of unsatisfactory performance by the Contractor as observed by the Quality Assurance Inspector.

ACCIDENT REPORTING. An accident constitutes any and all incidents or acts involving the Contractor, which may or may not have caused obvious damage to persons or property. All accidents shall be reported to the Contracting Officer within 24 hours of the occurrence. All serious accidents (those resulting in death or injury requiring medical attention) shall be reported immediately.

HERBICIDE. The term "herbicide" means (1) any substance or mixture of substances intended for preventing, destroying, and/or repelling any herbaceous or woody vegetation (2) any substance or mixture of substances intended for use as a plant regulator, defoliant, or desiccant

DIAMETER AT BREAST HEIGHT (D.B.H.). The term d.b.h. is an acronym for diameter at breast height and represents the standard tree diameter measurement taken at four and a half (4.5’) feet above the ground.

Appendix D - 1: Pre-Use Pesticide Form

U. S. ARMY CORPS OF ENGINEERS

ST. LOUIS

CLARENCE CANNON DAM AND MARK TWAIN LAKE

CHEMICAL USAGE WORK SHEET

PRE-USE PESTICIDE APPLICATION FORM

CONTRACT / LEASE NO. DACW43-________________ TRACT NO.___________

CONTRACTOR/LESSEE___________________________

Address:

City: _________________ ST__________ Phone_____________________________

APPLICATOR’SNAME____________________ STATE LICENSE NO.__________

Address: __________________________________ Category Title: _________________ City: __________________ ST__________ Date of Expiration:_____________Phone:_____________________________

TARGET PEST______________________________________________________

DESCRIPTION OF TREATED AREA___________________________________

PESTICIDES (TRADE NAME) _____________________________________________

FORM APPLIED_________________________________________________________

ACTIVE INGREDIENTS _________________________________________________

EPA REGISTRATION _____________________EPA CLASSIFICATION__________

(SINGLE WORD)

ADDITIONAL REMARKS ________________________________________________

DISAPPROVED BY: __________________________ DATE: ____________________

Operations Manager

APPROVED BY: ______________________________DATE:____________________

Operations Manager

• Pesticides must be approved by the Mark Twain Lake Project Office before pesticides are applied.

Appendix D– 2: Post Use Pesticide Form

U. S. ARMY CORPS OF ENGINEERS

ST. LOUIS

CLARENCE CANNON DAM AND MARK TWAIN LAKE

CHEMICAL USAGE WORK SHEET

POST-USE PESTICIDE APPLICATION FORM

CONTRACT / LEASE NO. DACW43-_________ APPLICATION DATE _________

CONTRACTOR/LESSEE________________ APPLICATOR’SNAME____________

Address: _____________________________ Address: ___________________________

City: __________________ST___________ City: __________________ST__________ Phone: ______________________________Phone_____________________________

TARGET PEST__________________________________________________________

DESCRIPTION OF TREATED AREA________________________________________

PESTICIDES (TRADE NAME) ______________________________________________

FORM APPLIED_________________________________________________________

ACTIVE INGREDIENTS__________________________________________________

EPA REGISTRATION _____________________EPA CLASSIFICATION___________

(SINGLE WORD)

POST APPLICATION

HOW THE PESTICIDE WAS MIXED: APPLICATION RATE DATE TREATED

TIME OF AIR RELATIVE CLOUD WIND DIRECTION ACREAGE

DAY TEMP HUMIDITY COVER AND SPEED TREATED

__: __ _____ __________ _______ __________MPH ______AC

APPLICATION EQUIPMENT USED_____________________ AMOUNT APPLIED

____________________________________________________I _________________

DISPOSAL INFORMATION

DISPOSAL DATE ___________

METHOD_______________________________________________________________

LOCATION_____________________________________________________________

ADDITIONAL REMARKS ________________________________________________

*Post-use pesticide application forms must be completed and submitted to the Mark Twain Lake Project Office within 48 hours of completion of application.

Appendix E-1 Accident Prevention Program

Appendix E-2 Accident Prevention Program

Appendix E-3 Accident Prevention Program

Appendix E-4 Accident Prevention Program

DISPOSAL DATE ___________