Exhibit_04B_SCNF_Master_Application_Record_South_Zone_Final_022016.pdf

2016 SCNF IDIQ Exhibit 4B: Salmon-Challis National Forest

H/C 63, Box 1669, Challis, ID 83226 Inventory______________________

South Zone Herbicide Application Record FACTS________________________

This Record is Required by Law and Must be Completed within 24 Hours of Herbicide Application

GPS File: Infestation ID: FACTS ID:

Site Description

Treatment Area Name/Location: Date(MM/DD/YY):

Site Type: Admin.________

Rec. Site_______

Forest_________

Riparian_______

Rangeland_______

Pasture__________

ROW__________

Trailhead_______

Other

(Specify)_____________________________

Application Information Prof. Applicator/License No:_____________________________ Prof. Applicator/License No:____________________________________ Prof. Applicator/License No: _______________________________ Prof. Applicator/License No:___________________________________

Other Applicators:

Equipment

Used: Backpack ______

ATV _____

Truck _____

Mechanical _____ Temp. Range: _________ to _________

Application Time: to Distance to Water: <15ft._____ 15-50 ft._____ >50ft._____ >100ft._____

Wind Speed: Wind Direction: Precipitation: Treatment Type: Broadcast Spot

Target Species: Non Target Vegetation:

Herbicide/Adjuvant Usage

Product Active Ingredient

EPA

Reg. #

Calibration

Rate

(Gal/Acre)

Rate

Applied

(Oz./Acre)

Total

Volume

Applied

(Gallons)

Amount

Applied

(Ounces)

Acres

Treated

(Chemical)

Total

Treatment

Area

(Acres)

Milestone Aminopyralid 62713-519

Plateau Imazapic 241-356

Telar XP Chlorsulfuron 352-654

Tordon 22K Picloram 62719-6

Transline Clopyralid 62719-259

2, 4-D

LI 700 /SS 7000

R11 / S-90/ NIS

MSO / SylTac

Bullseye Dye

Plant Phenology (Dominant Life Stage)

TX APPLICATION VISUAL MONITORING -Total App. Hours ______ Were any adverse effects identified during the application? (# People x total hrs worked)

No Yes (if yes, explain in the Notes) -Total Person Days ______ (Total App. Hours ÷ 10 Hrs)

NOTE- If adding more than 1 herbicide to a tank make sure to display it in Herbicide Name column. (For example: Telar + 2, 4-D)

Record initial amount mixed, gallons used, amount leftover @ end of day & amount applied by Person.

Herbicide Name Initial Amount Mixed Gallons Used Amount Leftover

TOTAL

Record specific amount of herbicide output by NRIS Site ID (If in a new infestation take a Weed Pt; if in a known infestation take a Qwik Pt ) NRIS ID/Plant Code Herbicide Gallons NRIS ID/Plant Code Herbicide Gallons New Species/Location Herbicide Gallons

Mechanical Treatment: Circle type (Pull, Clip Seed heads,)

NRIS ID Quantity Tx NRIS ID Quantity Tx Notes: (e.g. site description, weed cover, and density, water sources, hazards, etc.

Plant Code Phenology (Dominate)

Amount Applied by Person

Name Volume (Gal)