Attachment 2 - PesticideAppRecord.pdf

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Attached to
W9128F21Q0076 - Zorinsky Tree Removal Phase 2 Federal contract opportunity
Solicitation number
8587
Issued by
Department of the Army Corps of Engineers Engineering District Omaha

About this file

This document contains a federal contract solicitation for tree removal services. The solicitation is for Phase 2 of the Zorinsky Tree Removal project to create a 30 foot wide firebreak zone around the perimeter of the Papio Creek Dam Site 18 property by removing all trees 6 inches or more in diameter, as well as smaller woody vegetation. Services include saw cutting, stump grinding, root ball removal or other removal methods for trees, and herbicide treatment and removal of cut woody vegetation. The firebreak zone is also to be cleared of debris and seeded. A mandatory site visit will be held on September 1, 2021 at 10am to register and receive the meeting location. The solicitation was issued by the Department of the Army Corps of Engineers Omaha District for tree removal at Lake Zorinsky in Omaha, Nebraska.

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Text version

PESTICIDE APPLICATION RECORD SHEET

Corps of Engineers, Omaha District

ER 1130-2-540 FIELD OFFICE: DATE:

PREPARED BY: PHONE: ( )

Check one: ANTICIPATED USAGE REQUEST

ACTUAL USAGE REPORT

COMPLETE THIS SECTION FOR BOTH ANTICIPATED USAGE REQUEST AND FOR AN ACTUAL USAGE

REPORT

TARGET PEST:

SPECIFIC DESCRIPTION OF SITE(S):

PESTICIDE TRADE NAME:

MANUFACTURER:

EPA REGISTRATION NO:

EPA CLASS: GENERAL FORMULATION: LIQUID

RESTRICTED GRANULAR

PESTICIDE MIXTURE:

(if applicable) (i.e. 1 gallon/50 gallons water)

APPLICATION RATE:

(i.e. gals./sq.ft. or lbs./acre)

NUMBER & TIMING OF APPLICATIONS:

USE THIS SECTION FOR ACTUAL USAGE REPORT ONLY

DATE PESTICIDE WAS APPLIED: TIME:

APPLICATION EQUIPMENT &

METHOD OF APPLICATION:

APPLIED BY: Corps employee Contractor

NAME OF APPLICATOR:

ADDRESS:

(if contractor)

PHONE:

TOTAL AREA OF BUILDINGS TREATED:

TOTAL AMOUNT OF PESTICIDE USED:

FOR OUTSIDE APPLICATIONS:

WIND: Calm WIND DIRECTION:

0-10 mph TEMPERATURE:

10-20 mph HUMIDITY:

Other> SOIL: wet moist dry

CEMVR FORM 55-E, 01 Aug 00 (Revised) Previous editions of this form are obsolete

FIELD OFFICE:
Date:
PREPARED BY:
Area Code:
Prep Phone #:
Anticipated Usage: Off
Actual Usage: Off
TARGET PEST:
TARGET PEST 1:
SPECIFIC DESCRIPTION OF SITES:
Specific Description 1:
PESTICIDE TRADE NAME:
MANUFACTURER:
EPA REGISTRATION NO:
General: Off
Restricted: Off
Liquid: Off
Granular: Off
PESTICIDE MIXTURE:
APPLICATION RATE:
NUMBER TIMING OF APPLICATIONS:
DATE PESTICIDE WAS APPLIED:
TIME:
METHOD OF APPLICATION:
Corps Employee: Off
Contractor: Off
NAME OF APPLICATOR:
Applicator ADDRESS:
Applicator Area Code:
Applicator Phone Number:
TOTAL AREA OF BUILDINGS TREATED:
TOTAL AMOUNT OF PESTICIDE USED:
Calm: Off
0-10 mph: Off
10-20 mph: Off
WIND DIRECTION:
TEMPERATURE:
HUMIDITY:
Other: Off
Soil: Off
Wet: Off
Moist: Off
Dry: Off
Reset Form:

File details come from the government source that posted it. Updated .