B08_Attachment_9_PAR_Template.pdf
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- Attached to
- BLM WASHOE HERBICIDE TREATMENTS 2026
- Solicitation number
- 140L3726Q0110
About this file
This is a Bureau of Land Management (BLM) Pesticide Application Record form required by law to document pesticide applications on federal lands.
The form captures comprehensive details of pesticide applications and must be completed within 24 hours of application completion, with records maintained for 10 years or as required by BLM regulations. Key information sections include: project identification (project name, operator, pesticide use proposal number, and EA/EIS references); applicator details (names of individuals applying pesticides); application timing (dates and time frame); specific location data (county, township, range, section, longitude, and latitude); equipment type used; and detailed pesticide information organized in a table format (manufacturer, trade name, formulation type, product amount per acre, unit per acre, active ingredient per acre, and acid equivalent per acre). The form also requires documentation of actual area treated in acres, total area protected, general vegetation type (native range, seeding, or disturbed), primary pest(s) involved, pest development stage, and weather conditions at time of application (wind velocity, wind direction, and temperature). A monitoring record section allows for notes on post-application observations, and the form concludes with signature, date, and applicator's license number fields for certification and accountability.
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Text version
BUREAU OF LAND MANAGEMENT – PESTICIDE APPLICATION RECORD
This record is required by law and must be completed except for monitoring within 24 hours after completion of application of pesticides. This record must be maintained of 10 years (or as required by BLM regulations).
1. a. Project Name: _________________________________________________________
b. Operator: _____________________________________________________________
c. Pesticide Use Proposal Number: ___________________________________________
d. EA/EIS Reference Numbers: _______________________________________________
2. Name of Applicator or Employee(s) Applying the Pesticide:
3. Dates(s) of Application: (MM/DD/YYYY)
4. Time Frame of Application: Start: End:
5. Location of Application: County: _____________________ _____; T._____ R._____ Sec._______
Longitude: _______________________ Latitude: _______________________________
6. Type of Equipment Used: _________________________________________________________
7. Pesticide(s) Used:
Manufacturer Trade
Name
Formulation
Type
Product amount per
Acre
Unit per acre
Active
Ingredient per acre
Acid
Equivalent per acre
8. a. Actual Area Treated: ___________ Acres (rate X amount of mixture used)
b. Total Area Protected: ___________ Acres (estimate or GPS acres treated)
9. General Vegetation of Treated Area: ________________________________________________
[___] Native range; [___] Seeding (non-native&/or native); [___] disturbed
10. Primary Pest(s) Involved: _________________________________________________________
11. Stage of Pest Development: _______________________________________________________
12. Weather Conditions: Wind velocity ________ Wind direction ________ Temperature ________
13. Monitoring Record (continue on back if necessary): ____________________________________
14. ___________________________________________________________________________
Signature Date Applicators License Number
File details come from the government source that posted it. Updated .