Appendix I Pesticide Control Plan.pdf

This is an appendix template from an Annual Pesticide Control Plan used to document pesticide applications for a calendar year. The form serves as both an anticipated usage report and an actual usage report to track pesticide activities across specified locations and districts.

The template requires documentation of application information including whether work was performed in-house, by contract, or resulted in a negative report, along with the applicator/contractor name and license number. Pesticide information sections capture the trade name, EPA class, EPA registration number, diluent, mixing rate, application rate, method of application, and number of applications. Site information details include target pest(s), location description(s), quantity of pesticide used, and total estimated acreage treated. The form also requires identification of whether an activity hazard analysis will be conducted with explanation of the yes or no response. Per the referenced ER 1130-2-540 dated November 15, 1996, pesticides include fungicides, herbicides, insecticides, larvicides, and rodenticides. The form is templated with blank fill-in fields and checkboxes for the user to complete based on actual pesticide control activities.