Attachment_5_Sample_Pesticide_Application_Record.docx

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Herbicide Treatment of Invasive Annual Grass
Solicitation number
140L0625Q0001
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This document is a Pesticide Application Report (PAR) template that provides a standardized format for recording details of pesticide applications, including treatment location, application methods, chemical products used, and plant species information.

The PAR captures key details such as the project name, treatment location, application date and time, weather conditions, equipment used, pesticide product information (including EPA registration numbers), application rates, and targeted plant species with estimated percent coverage. The template also includes an optional section for a sketch map of the treated area. This form appears to be used by the Department of the Interior Bureau of Land Management for documenting pesticide applications within their areas of responsibility.

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Pesticide Application Report (PAR)

LOCATION INFORMATION

BLM Project Name

Treatment Name

ProjectName_TreatmentName_GenusSpeciesSymbol(as many as treated)_DATE (ex. 07092024)

Exact Location of Treatment Site:

(ex:38.468218, -108.101364)

County / State:

BLM Field Office:

TREATMENT INFORMATION

Treatment Date (ex: 6/1/2014)

Treatment Start Time (ex: 0800)

End Time (ex: 1600)

Temperature (F)

Wind Speed / Direction

Soil Moisture (circle one) Wet Moist Dry Humidity %

BLM PUP #

(ex: WYP070-14-003-P)

ORV050-2023-001-P
Equipment Used (circle one)
TRUCK – ATV – UTV - BACKPACK – AIRPLANE - HELICOPTER – HANDHELD SPRAYER – WICK/WIPER – MOWER – TRACTOR – HORSEBACK SPRAYER

Applicator Name /license #/Role (ex: John Doe/14-001/ Applicator)

Mix Diluent (circle one)

WATER – OIL - NONE

Sprayer Calibration Rate (ex: 2 GALLONS/ACRE) (circle appropriate Rate)

GALLONS/ACRE

OUNCES/ACRE

PINTS/ACRE POUNDS/ACRE

QUARTS/ACRE

Distance to Water (circle one)
0 TO 10 FEET - 10 TO 25 FEET

25 TO 100 FEET - GT 100 FEET

Delivery Method:

AERIAL - GROUND

Spray Pattern:

BROADCAST - SPOT

Total Acres Treated:

FOR SPOT APPLICATIONS ONLY

Mix Amount Applied on Site (ex: 2 GALLONS)
GALLONS

CHEMICAL BRAND(s) APPLIED - In formulated product units

CHEMICAL TRADE NAME (ex: Roundup Pro)
MANUFACTURER

(ex: MONSANTO, BASF)

EPA REG #

(ex: 524-475, 7969-150)

CHEMICAL

COMMON NAME

(ex: Glyphosate)

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)
MANUF

(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

SPECIES INFORMATION

SPECIES CODE

(ex: ACRE3)

SPECIES COMMON NAME

(ex. Russian Knapweed)

PLANT PHENOLOGY

(circle one) ESTIMATED PERCENT COVER (circle one)

BARE GROUND – BOLT – BUD – DORMANT – FLOWER – MATURE – PRE-BUD – ROSETTE – SEED SET – SCENESCENT - VEGETATIVE

Trace (Less than 1%) – Low (1-5%) – Medium (5-25%) - High (25-100%)

BARE GROUND – BOLT – BUD – DORMANT – FLOWER – MATURE – PRE-BUD – ROSETTE – SEED SET – SCENESCENT - VEGETATIVE

Trace (Less than 1%) – Low (1-5%) – Medium (5-25%) - High (25-100%)

BARE GROUND – BOLT – BUD – DORMANT – FLOWER – MATURE – PRE-BUD – ROSETTE – SEED SET – SCENESCENT - VEGETATIVE

Trace (Less than 1%) – Low (1-5%) – Medium (5-25%) - High (25-100%)

BARE GROUND – BOLT – BUD – DORMANT – FLOWER – MATURE – PRE-BUD – ROSETTE – SEED SET – SCENESCENT - VEGETATIVE

Trace (Less than 1%) – Low (1-5%) – Medium (5-25%) - High (25-100%)

BARE GROUND – BOLT – BUD – DORMANT – FLOWER – MATURE – PRE-BUD – ROSETTE – SEED SET – SCENESCENT - VEGETATIVE

Trace (Less than 1%) – Low (1-5%) – Medium (5-25%) - High (25-100%)

BARE GROUND – BOLT – BUD – DORMANT – FLOWER – MATURE – PRE-BUD – ROSETTE – SEED SET – SCENESCENT - VEGETATIVE

Trace (Less than 1%) – Low (1-5%) – Medium (5-25%) - High (25-100%)

BARE GROUND – BOLT – BUD – DORMANT – FLOWER – MATURE – PRE-BUD – ROSETTE – SEED SET – SCENESCENT - VEGETATIVE

Trace (Less than 1%) – Low (1-5%) – Medium (5-25%) - High (25-100%)

Sketch Map Area (optional)

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