Attachment 7 - Daily Pesticide Application Record.doc

32 KB Posted

Attached to
GMUG NF Noxious Weed Spraying & Mapping
Solicitation number
1240LQ23Q0055
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USDA Forest Service

Grand Mesa, Uncompahgre & Gunnison National Forests Daily Pesticide Application Record

Ranger District: ____________________________ Date: ____________ Location of Application

Drainage: _________________________ Specific Location: _____________________

Township: ________ Range: ______ Section(s): ____________________________

Township: ________ Range: ______ Section(s): ____________________________

Township: ________ Range: ______ Section(s): ____________________________

Land Ownership: FS___BLM___State___PVT___Other___________

Job Code: _______________

Application Information

Time: Start _______ End _______ Start _______ End _______

Initial Treatment _____ Re-treatment _____

Weather Conditions: Clear _____ Cloudy ______ Partly Cloudy _____

Wind Speed: ________mph, from __________ Temperature _________

** Calibration/Maintenance of Equipment Y/N_______

**In/Over Water Y/N____ **Near Water Y/N____ (below seasonal floodplain) **Treatment Monitoring Comments: (negative impacts observed?) ______________________________ Target Weeds

(List most abundant weed first)

Stage of Growth: Bud _____ Flowering _____Seeding _____

Site of Application:

Rangeland___ Campground___ Trailhead___ Right of Way___ Other______________

Herbicides Used:

Name: __________________ EPA number: _________________ Rate (AI) per acre: _______

Name: __________________ EPA number: _________________ Rate (AI) per acre: _______

Name: __________________ EPA number: _________________ Rate (AI) per acre: _______

Name: __________________ EPA number: _________________ Rate (AI) per acre: _______

Name: __________________ EPA number: _________________ Rate (AI) per acre: _______

Name: __________________ EPA number: _________________ Rate (AI) per acre: _______

Dilutant Used: ________ Gallons per Acre: ______ Total Gallons Mix applied: ______

Application Method: ____________________Calibrated Acres Treated: __________

Empty Containers Triple Rinsed: Yes _____ No _____

Disposal Site: ________________________________

Affected Acres Treated: ________

Affected Acreage Justification/Comments: _______________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________

Applicator’s Signature: _________________________________________________

Certified Applicator’s Signature: __________________________________________

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