Attach 6 Application Record Template.docx
DOCX document 36 KB Posted
- Attached to
- HERBICIDE APPLICATION - SHEEP CREEK HERBICIDE Federal contract opportunity
- Solicitation number
- 140L3921Q0053
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attach 8 GIS Files.zip | ZIP file | |
| Attach 7 Maps.pdf | ||
| Attach 2 Detailed Specifications.docx | DOCX document | |
| Attach 5 Applicaion Example.pdf | ||
| Attach 4 BLM_Herbicide.pdf | ||
| Sol_140L3921Q0053.pdf | ||
| Attach 9 SCA Wage Determination 2015-5601.pdf | ||
| Attach 1 Statement of Work.doc | DOC document | |
| Attach 3 BLM_Adjuvants.pdf |
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Text version
| GROUND - Pesticide Application Record (PAR) | Contract or Agreement Number:________________________ |
| Bureau of Land Management Elko District | BLM Project Name: __________________________________ |
| 3900 Idaho St Elko, NV 89801 | Company Name: ______________________________________ |
| TREATMENT INFORMATION |
Date (ex: 6/1/2014) BLM PUP # (Refer to page 2 for a list)
Weather Reading time (START):
| Temperature °F: |
| RH %: |
| Wind Direction: |
| Wind Max mph: |
| Wind Avg mph: |
Weather Reading time (STOP):
| Temperature °F: |
| RH %: |
| Wind Direction: |
| Wind Max mph: |
| Wind Avg mph: |
Licensed Applicator Name, License Number AND Crew Members
Mix Diluent (circle one)
WATER
OIL
NONE
Equipment Used (circle one) TRUCK – ATV – UTV - BACKPACK – AIRPLANE - HELICOPTER – HANDHELD SPRAYER – WICK/WIPER – MOWER
TRACTOR – HORSEBACK SPRAYER
Sprayer Calibration Rate (ex: 2 GALLONS/ACRE) (circle appropriate Rate)
GALLONS/ACRE
POUNDS/ACRE
Distance to Water (circle one)
0 TO 10 FEET
10 TO 25 FEET
25 TO 100 FEET
GREATER THAN 100 FEET
Delivery Method (circle one)
| AERIAL – GROUND |
| Spray Pattern |
(circle one)
BROADCAST – SPOT
Mix Amount Applied on Site (ex: 2 GALLONS)
Total Acres Treated: (ex: 40 ACRES)
Swath Width of Equipment (Broadcast Only) (ex: 50 FEET; NA for SPOT)
FOR LINEAR FEATURES ONLY (i.e. road or stream)
Buffer Width
| Buffer Width Units |
| FEET |
| Buffer Direction |
(circle one)
LEFT - CENTER - RIGHT
Note on Buffer Direction: left or right will buffer in only one direction, while center will buffer both sides based on the width and units provided. For instance a right buffer of 10 feet will buffer 10 feet on the right only while a center buffer of 10 feet will buffer both sides of the centerline (total buffer is 20 feet)
CHEMICAL BRAND(s) APPLIED - In formulated product units
| CHEMICAL TRADE NAME (ex: Roundup Pro, Overdrive) |
| MANUFACTURER |
(ex: MONSANTO, BASF)
EPA REG #
(ex: 524-475, 7969-150)
CHEMICAL
COMMON NAME
(ex: Glyphosate, Dicamba + Diflufenzopyr)
RATE OF APPLICATION
Liquid ex: 2 QUARTS PER ACRE, , 8 FLUID OUNCES PER ACRE, 1 PERCENT SOLUTION Dry ex: 0.50 POUND PER ACRE, 1 OUNCE PER ACRE
ADJUVANTS BRAND(s) APPLIED - In formulated product units
| ADJUVANT BRAND NAME (ex: DYNE_AMIC) |
| MANUFACTURER |
(ex: HELENA CHEMICAL)
RATE OF APPLICATION
Liquid ex: 2 QUARTS PER ACRE, , 8 FLUID OUNCES PER ACRE, 1 PERCENT SOLUTION Dry ex: 0.50 POUND PER ACRE, 1 OUNCE PER ACRE
Per BLM policy, Pesticide Application Records must be completed within 24 hours of pesticide application and are kept for a minimum of 10 years.
Associated Tracklog(s) File ID: (ex: CraneSprings06052020_01)
Elko District Pesticide Use Proposal (PUP) Numbers:
NVE000-19-002-P =2,4-D
NVE000-19-003-P = Chlorsulfuron NVE000-19-004-P = Clopyralid NVE000-19-005-P =Dicamba NVE000-19-006-P =Glyphosate NVE000-18-001-P =Imazapic NVE000-19-007-P =Imazapyr NVE000-19-008-P =Metsulfuron methyl NVE000-19-009-P =Picloram NVE000-19-010-P =Sulfometuron NVE000-19-011-P =Triclopyr
NOTES/COMMENTS:
(i.e. Rain event? If so, time of rain event? Duration? Was it a wetting rain? When did you stop your application?)
SPECIES INFORMATION
SPECIES COMMON NAME
(ex. Russian Knapweed)
SPECIES CODE
(ex: ACRE3)
PLANT PHENOLOGY
(circle one)
ESTIMATED PERCENT COVER
(1 -100%)
BARE GROUND – BOLT – BUD DORMANT – FLOWER MATURE – PRE-BUD ROSETTE – SEED SET SCENESCENT – VEGETATIVE
BARE GROUND – BOLT – BUD DORMANT – FLOWER MATURE – PRE-BUD ROSETTE – SEED SET SCENESCENT – VEGETATIVE
BARE GROUND – BOLT – BUD DORMANT – FLOWER MATURE – PRE-BUD ROSETTE – SEED SET SCENESCENT – VEGETATIVE
BARE GROUND – BOLT – BUD DORMANT – FLOWER MATURE – PRE-BUD ROSETTE – SEED SET SCENESCENT – VEGETATIVE
Weed Species Reference Information
| Common Name |
| Code |
| Common Name |
| Code |
| African mustard |
| BRTO |
| Mayweed chamomile |
| ANCO |
| African rue |
| PEHA |
| Mediterranean sage |
| SAAE |
| Austrian fieldcress |
| ROAU |
| Medusahead |
| TACA8 |
| Black henbane |
| HYNI |
| Musk thistle |
| CANU |
| Camelthorn |
| ALMA |
| Perennial pepperweed |
| LELA2 |
| Canada thistle |
| CIAR4 |
| Perennial sowthistle |
| SOAR |
| Common crupina |
| CRVU |
| Poison-hemlock |
| COMA |
| Common St. Johnwort |
| HYPE |
| Puncturevine |
| TRTE |
| Crimson fountain grass |
| PESE |
| Purple loosestrife |
| LYSA |
| Dalmation toadflax |
| LIDA |
| Purple starthistle |
| CECA |
| Diffuse knapweed |
| CEDI3 |
| Rush skeletonweed |
| CHJU |
| Dyer's woad |
| ISTI |
| Russian knapweed |
| ACRE3 |
| Eurasian watermilfoil |
| MYSP |
| Salt cedar |
| TARA |
| Giant reed |
| ARDO |
| Scotch thistle |
| ONAC |
| Giant salvinia |
| SAMO |
| Silverleaf nightshade |
| SOEL |
| Goatsrue |
| GAOF |
| Spotted knapweed |
| CEST8 |
| Hoary cress |
| CADR |
| Squarrose knapweed |
| CEVI |
| Horsenettle |
| SOCA |
| Sulfur cinquefoil |
| PORE |
| Houndstongue |
| CYOF |
| Swainsonpea |
| SPSA |
| Hydrilla |
| HYVE |
| Syrian bean caper |
| ZYFA |
| Iberian starthistle |
| CEIB |
| Waterhemlock |
| CIMA |
| Johnsongrass |
| SOHA |
| Yellow starthistle |
| CESO |
| Leafy spurge |
| EUES |
| Yellow toadflax |
| LIVU |
| Malta starthistle |
| CEME |
| Cheatgrass |
| BRTE |
| Ventenata dubia |
| VEDU |
| Russian thistle |
| SATR12 |
Per BLM policy, Pesticide Application Records must be completed within 24 hours of pesticide application.
File details come from the government source that posted it. Updated .