Attachment 08 - Pest Management Application Reporting Form V 2.1 (20 MAR 2024).docx
DOCX document 31 KB Posted
- Solicitation number
- W911SA25QA033
About this file
This is a pest management application reporting form template used by the 88th Readiness Division to document individual pest control operations. The form requires detailed documentation of pest control activities including date, location (interior/exterior), facility information, type of pest control operation, site description, target pest, area treated (with specific measurement units), applicator information, and comprehensive pesticide/herbicide details such as trade name, active ingredients, EPA registration numbers, formulation, quantity applied, and final concentration.
This form appears to be an attachment to solicitation W911SA25QA033 for grounds maintenance services at an Army Reserve Facility in Hayden, ID. While the form itself is a template for reporting pest control activities, it is being provided as part of a broader grounds maintenance contract that has an active performance period of eight months (May through November) and a non-active period of four months (December through March).
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 6 - ID017 Grounds Price Schedule (blank) V2.xlsx | XLSX spreadsheet | |
| W911SA25QA033 Soliciation Amendment 2.pdf | ||
| W911SA25QA033 0001 Solicitation Amendment.pdf | ||
| Attachment 05 - Wage Determination Log V2.xlsx | XLSX spreadsheet | |
| Attachment 11 - Question and Answers.docx | DOCX document | |
| W911SA25QA033 Solicitation.pdf | ||
| W911SA25QA033 Solicitation.pdf | ||
| Attachment 03 - PRS V 2.2 (03 JUN 2024).xlsx | XLSX spreadsheet | |
| Attachment 06 - ID017 Price Schedule - CUI.xlsx | XLSX spreadsheet | |
| Attachment 07 - Drawings 15 May 2024.pdf | ||
| Attachment 01 - PWS V2.2 (03 JUN 2024).docx | DOCX document | |
| Attachment 09 - DOD Pesticides List 20191101.pdf | ||
| Attachment 05 - Wage Determination Log.xlsx | XLSX spreadsheet | |
| Attachment 10 - Service Ticket V 2.2 (03 JUN 2024).docx | DOCX document | |
| Attachment 02 - AT-OPSEC.pdf | ||
| Attachment 04 - Deliverables V 2.1 (20 MAR 2024).docx | DOCX document |
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Text version
88th Readiness Division
UNIVERSAL PEST MANAGEMENT APPLICATION REPORTING FORM
A separate form shall be filled out for each pest management operation.
Please print for number 1-9.
1. Date of Application: _________________________
2. Location: 2a. Inside or Outside (circle one) 2b. Facility name and/or building #: _______________________________________
3. Type of Pest Control Operation: ______________________________________________ (e.g., baiting, power spray, ULV, manual application of pesticide etc.)
4. Site Description: ______________________________________ (e.g., office, lawn, unimproved ground, fence line, parking lot cracks, etc.)
5. Pest: _________________________________________(rodents, spiders, nates, weeds, etc.)
6. Area Treated: _________________________________ [Include unit, SF (square feet), LF (linear feet), AC (acre), CF (cubic feet), EA (each - for baiting only)]
7. Applicator’s Name: ___________________________________
8. Pesticide/Herbicide Used:
8a. Pesticide/Herbicide Trade Name: _______________________________________ 8b. Pesticide/Herbicide Active Ingredient: ___________________________________ 8c. EPA or Country Reg #: ________________________________________________ 8d. Formulation: _________________________________________________________ 8d. Quantity of pesticide applied: ___________________________________________ [include unit, FL (fluid ounce), GA (gallon), ML (milliliter), LT (liter), LB (pound), DR (dry ounce), GR (gram), KG (kilogram)] 8e. Final Concentration Applied: _______________________________________ (amount of active ingredient per acre/area)
9. Comments: (survey results, wind conditions, sanitation deficiencies, etc.)
10. Signature of Applicator: ____________________________________________
11. Certification # of Applicator: _________________________________________
12. Copy sent to 88th PMC on (date)____________
File details come from the government source that posted it. Updated .