Attachment 4 - Post Application Documentation Form.pdf

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Attached to
Pool 5 Rolling Prairie Restoration
Solicitation number
W912ES25QA021
Issued by

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The document is a Post-Application Documentation Form for a Pest Control Program issued by the U.S. Army Corps of Engineers, St. Paul District. The two-page form is designed to capture comprehensive details about a pesticide application, including information about the contractor, applicator, target pest, application conditions, and specific pesticide usage. The form requires detailed documentation such as application date, time, temperature, humidity, wind direction, and acreage treated, as well as specifics about the pesticide itself, including trade name, EPA registration, active ingredients, mixing method, application rate, and disposal information.

The form is specifically associated with the Pool 5 Rolling Prairie Restoration contract (Solicitation Number: W912ES25QA021), which involves restoration of prairie and wetland on approximately 71.4 acres of agricultural land owned by the U.S. Army Corps of Engineers in Wabasha County, Minnesota. This documentation form appears to be a critical component for tracking and reporting pest control activities during the land restoration process, ensuring precise record-keeping of environmental management procedures.

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Other files

File Type Posted
Attachment 1 - Parcel Map.pdf PDF
Wage Rates - Wabasha County.pdf PDF
Attachment 3 - Vicinity Map.pdf PDF
Attachment 2 - Management Actions Map.pdf PDF
W912ES25QA021 Solicitation.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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