Exhibit 3e Pesticide Application Record.pdf
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- Solicitation number
- 1240LS24R0002
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a Pesticide Application Record form used by the United States Department of the Interior Bureau of Land Management for a federal contract opportunity.
The key details are: The form captures information about pesticide applications, including the applicator, application dates and location, pesticide details, application conditions, and targeted pests. It requires completion within 24 hours of the application and must be kept on file for a minimum of 10 years.
The related federal contract opportunity is for Invasive Species/Rare Plants Vegetation Management Services, an Indefinite Delivery/Indefinite Quantity (IDIQ) contract solicited by the U.S. Forest Service under Solicitation Number 1240LS24R0002. The contract will provide vegetation management services, including the use of pesticides as documented in this form.
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Text version
UNITED STATE DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
PESTICIDE APPLICATION RECORD
Project Name: ________________________________________________________________________
Operator: ___________________________________________________________________________
Pesticide Use Proposal Number: __________________________________
NEPA Reference Number: __________________________________
1. APPLICATOR:
a. Name of Applicator or Employee(s) Making the Application:
2. APPLICATION:
a. Application Dates: ______________________ ______________________
b. Time Frame of Application: ______________________ ______________________
c. Location: _________________________________________________________________
d. Application Equipment: _______________________________________________________
3. PESTICIDE INFORMATION:
a. Trade Name: ______________________________________________________________
b. Company/Manufacturer/Formulator’s Name: ____________________________________
c. Pesticide Formulation Type: ____________________________________________________
d. Rate of Application – Per Acre:
i. Formulated Product: _________________________________________________
ii. Active Ingredient/Acid Equivalent: _______________________________________
iii. Total Spray Solution Amount: __________________________
4. APPLICATION CONDITIONS:
a. Wind Speed: ____________________ Wind Direction: ______________________
b. Air Temperature: ___________________ Surface Conditions: ___________________
5. APPLICATION AREA:
c. Area Treated – Based upon JD Definition: ________________________________ Acres.
d. Area Treated – Based upon Chemical Used or Amount of Chemical Applied:
e. Status of Application Site (Circle One): Dry Moist
f. Status of Application Site (Circle One): Native Vegetation Seeded Vegetation
Other Type
6. TARGETED PEST(S):
Name Stage of Growth/Development
7. MONITORING RECORD:
NOTE:
1. This record is required and must be completed, except for monitoring, within 24 hours following application of the pesticide.
2. This record must be kept on file/maintained for a minimum of 10 years.
File details come from the government source that posted it. Updated .