Attachment_6__Pesticide_Applicator_Record_(PAR).pdf

Bureau of Land Management

Herbicide Treatment Record

4.1 Applicator Name

5. T. R. S. 6. Location Accuracy in Feet

4.2 Applicator License no.

7. Temp (F) 8. Wind Speed (mph) 9. Wind Direction 10. Humidity (%)

14. Diluent: □ Water □ Other (specify) a.

b.

c.

d.

28. Cover e.

f.

g.

30. Finish Date & Time 31. Total Volume of Mix Applied (gal.) 32. Notes

Entered By: Entered Date:

11. Soil Moisture: ( Dry , Moist , Wet ) 12. Distance to water: ( 0-10 ft , 10-25 ft , 25-100 ft , > 100ft)

19. Trade Name 20. Manufacturer 21. EPA Registration No. 22. Mix Rate 23.Unit of Measure

---------------------------------------------------------Herbicide---------------------------------------------------------------------------

( Back Pack Sprayer, Boom Sprayer, Hand Gun Sprayer, Injector, Wick )

17. Equipment Type

----------------------------------------------------------Adjuvant(s)---------------------------------------------------------------------------

24. Trade Name 25. Mix Rate 26. Unit of Measure

( Abandoned Cropland, Agriculture, Aquatic, Body of Water, Cultivated, Forest, Grassland, Landscaping, Riparian, Shrubland, Upland, Wetland, Woodland, Rangeland )

18. Treatment Area Physical Type:

27. Species Treated (USDA

Plant Code)

29. Phenology: (Bolt, Bud, Dormant, Flower, Mature, Pre-bud, Rosette, Seed set, Seedling, Senescent, Vegetative, Bare ground)

1. Project Name / Unit Number

3.2. Location UTMS If > .1 Acre Center Point of Polygon

(Include Map)

3.1. Location UTMs If < .1 Acre Center Point

2. Treatment Start Date & Time

15. Calibration Rate (gal./acre) 16. Coverage Pattern: (Spot , Broadcast, Band)

13. BLM Pesticide Use Proposal Number

1. Project name: Name of invasive plant project.

2. Treatment Start and Date: The date MM/DD/YYYY, Hour: Minutes, that application of herbicde began , e.g. 04/12/2020 , 13:00

6. Location Accuracy: Enter the known level of accuracy in feet based on equipment tolerances.

16. Coverage Pattern: Choose the one best descriptor for the application coverage type.

20. Manufacturer: Enter the name of the company that produces the herbicide.

21. EPA registration No. : Enter the Environmental Protection Agency registration number.

22. Mix Rate: Enter the quantity of herbicide that is used in the tank mix.

23. Unit of Measure: Enter the units of product over the units of diluent e.g. fluid oz. / gallons.

24. Trade name: Enter the brand name of the adjuvant(s) used.

25. Enter the quantity of adjuvant that is used in the tank mix.

26. Unit of Measure: Enter the units of product over the units of diluent e.g. fluid oz. / gallons.

28. Cover % : The average amount of ground covered by species being treated in the entire treatment area.

30. Finish date and time: The date MM/DD/YYYY, Hour: Minutes that the application to the treatment ended, e.g. 04/12/2020 , 15:25

32. Notes: Include relevant information that is not included in the prior fields.

18. Treatment Area Physical Type: Choose the one best descriptor for the physical area that the treatment is being applied.

19. Trade name: Enter the brand name of the herbicide used. If the PUP is for a tank mix of herbicides enter them all.

27. Treated Species (USDA Plants Code): Enter the species identifier code as displayed by the USDA plants website e.g. CYSC4 =

Cytisus scoparius, Scotch broom.

29. Phenology: Choose the one best descriptor for the dominant phenology of the treated species in the entire treated area.

31. Total Volume of Mix Applied: Record the cumulative amount of mix (diluent plus herbicide plus adjuvant) to the nearest 0.1 gallons.

13. BLM Pesticide Use Proposal Number: Enter the Pesticide Proposal Number (PUP) for herbicide used at the treatment site. If more than one PUP herbicide is used on the site complete an additional Herbicide Treatment Record Form.

This form is to be used for ground based herbicide application treatments on invasive plant infestations on federally managed public lands. A separate form is required for each treatment unit. A separate form is required for each day even with in the same treatment unit. A separate form is required for every Pesticide Use Proposal (PUP) used, even within the same treatment units and same day.

3.1 or 3.2 : Include Universal Transverse Mercator (UTM) at the center point of treatment, if treatments are larger than 1/10 th acre

(0.1 acre) then a map will be included witht hte herbicide treatment record showing the treatment shape and size with identifiable landmarks labeled, scale bar, and directional arrow at a 1:12,000 scale or smaller.

4.1 Applicator Name: Name of Licensed pesticide applicator or crew chief whom is present at time of application of herbicide treatment.

4.2 Applicator License No. : License Number of the named on-site herbicide applicator.

7. Temp (F): Enter the air temperature in degrees Fahrenheit taken in the shade during the application of herbicide.

8. Wind Speed: Enter the average wind speed taken at 4 ft from the ground during the application of herbicide.

9. Wind Direction: Enter the cardinal direction that the wind is originating from during the herbicide application period.

10. Humidity (%): Enter the relative humidity of the air at the treatment site at the time of application as a percentage from 1-100

11. Soil Moisture: Choose the one best descriptor for the moisture content of the soil at the treatment site.

12. Distance to water: Choose the one best descriptor of the treatment edge's nearest proximity to surface water.

17. Equipment Type: Choose one type of equipment used at the treatment site. Use multiple forms if multiple equipment types are used on the same treatment site.

14. Diluent: Place a check next to the diluent used in herbicide mix if other than water is used write the diluent that is used or none.

5. T. R. S. : Enter the Township (T.) Range (R.) and Section (S.) numbers.

15. Calibration Rate: Enter the average calibration rate of all spray equipment used on the treatment area. Individual applicators must know the calibration rate for their equipment and must determine the calibration rate when equipment is changed.

30. Finish date and time: The date MM/DD/YYYY, Hour: Minutes that the application to the treatment ended, e.g. 04/12/2020 , 15:25