Attachment 3 Post-Application Documentation Form.pdf

PDF 59 KB Posted

Attached to
Prescribed Burn of West Newton Prairie
Solicitation number
W912ES23Q0089
Issued by

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This document is a post-application documentation form for a pest control program conducted by the U.S. Army Corps of Engineers, St. Paul District. The form collects details on the date, time, weather conditions, acreage treated, target pest, pesticide used, application method, rates, equipment, and disposal information. It appears to document a past treatment under a pest control contract. The related federal contract opportunity is solicitation number W912ES23Q0089 for prescribed burn services at the West Newton Prairie, issued by the Department of the Army Corps of Engineers Engineering District St Paul. The form and solicitation suggest the Corps contracts for pest control and controlled burning services but no other salient details are provided.

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Other files

File Type Posted
Attachment 6 GoNoGoChecklist.pdf PDF
Attachment 2 Approved Herbicide List.xlsx XLSX spreadsheet
Attachment 4 WIPFC Qualifications-for-Prescribed-Fire-Personnel.pdf PDF
W912ES23Q0089 Solicitation.pdf PDF
Attachment 1 West Newton Vicinity and Prescription Maps.pdf PDF
Attachment 5 WIPFC_BurnPlanElements.pdf PDF

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POST-APPLICATION DOCUMENTATION FORM

PEST CONTROL PROGRAM

U.S. ARMY CORPS OF ENGINEERS, ST. PAUL DISTRICT

1114 South Oak St., La Crescent MN, 55947

Ph. 651-290-5899

APPLICATION INFORMATION

APPLICATION DATE: ______________________

CONTRACTOR: _________________________________ APPLICATOR: ___________________

Addr: ___________________________________________ Addr: ___________________________

City: ____________________________________________ City: ____________________________

Phone: ___________________________________________ Phone: __________________________

TARGET PEST: ______________________________________________________________________

DATE OF TIME OF AIR RELATIVE WIND DIRECTION ACREAGE

APPLICATION DAY TEMP HUMIDITIY CLOUD COVER AND SPEED TREATED

DESCRIPTION OF TREATED AREA:

PESTICIDE INFORMATION

PESTICIDE (TRADE NAME): _________________________________________________________________________________________

FORM APPLIED: _____________________________________________________________________________________________________

ACTIVE INGREDIENTS:

EPA REGISTRATION: _____________________________________ EPA CLASSIFICATON: ______________________________________

HOW THE PESTICIDE WAS MIXED: ____________________________________________________________________________________

APPLICATION RATE (TOTAL): ________________________ APPLICATION RATE (ACTIVE) __________________________________

INGREDIENT (S) : __________________________________________________________________________________________________

APPLICATION EQUIPMENT USED:

AMOUNT APPLIED: _________________________________________________________________________________________________

DISPOSAL INFORMATION DISPOSAL DATE: ____________________________

METHOD: _________________________________________________________________________________________________________

LOCATION: _________________________________________________________________________________________________________

ADDITTIONAL REMARKS: ____________________________________________________________________________________________

APPLICATION INFORMATION
PESTICIDE INFORMATION
APPLICATION DATE:
CONTRACTOR:
APPLICATOR:
Addr:
Addr_2:
City:
City_2:
Phone:
Phone_2:
TARGET PEST:
undefined_2:
undefined_3:
undefined_4:
undefined_5:
undefined_6:
DESCRIPTION OF TREATED AREA:
NAME:
FORM APPLIED:
EPA REGISTRATION:
EPA CLASSIFICATON:
HOW THE PESTICIDE WAS MIXED:
APPLICATION RATE TOTAL:
APPLICATION RATE ACTIVE:
INGREDIENT S:
APPLICATION EQUIPMENT USED:
AMOUNT APPLIED:
DISPOSAL DATE:
METHOD:
LOCATION:
ADDITTIONAL REMARKS:
ACTIVE INGREDIENTS:
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