Exhibit 4g Sample Treatment Form.pdf
PDF 202 KB Posted
- Solicitation number
- 1240LS24R0002
- Issued by
-
Department of Agriculture Forest Service
About this file
This document appears to be a Sample Treatment Form related to a federal contract opportunity for Invasive Species/Rare Plants Vegetation Management Services. The form provides details on the process for weed treatment, including the treatment type, application site, weed information, daily application log, and a table of herbicide products.
The related federal contract opportunity is Solicitation Number 1240LS24R0002 from the Department of Agriculture Forest Service for an Indefinite Delivery, Indefinite Quantity (IDIQ) contract for Invasive Species/Rare Plants Vegetation Management Services. The solicitation describes the requirement for vegetation management services in national forests, but does not provide additional details on the specific services, response dates, award dates, pricing terms, set asides, or other salient information.
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Text version
2022 Weed Treatment Data Record
Forest Treatment Recommended by: Owner Boise National Forest 1249 South Vinnell Way, Suite 200 Boise, Idaho 83709
Holly Hampton - Rangeland Management Specialist
FS
Method Code Equipment Code County 700 Chemical
100 Manual
Biological
Truck ATV/UTV Backpack
Hand Sprayer Horse pack
Elmore Boise Ada Camas
Site/Inventory Fields Treatment
Type Application Site
Applicator Names License #
Pesticide
Hand pull
Forest Rangeland Riparian Admin Campground
Trailhead Irrigation Ditch Right of Way Pasture
Weed
Weed Code
Cover Code T=0-1%, L=1-5%, M=5.1-25%, H=25.1- 100%
Phenology Rosette, Bud, Flower, Fall
% Polygon Infested NRIS (D1SFBR)
FACTS (SFBR)
Daily Log Application
Date Start Time Stop Time Acres Treated
Calibrated Total Acres
Calibrated Volume (water) (Gal/Acre)
Dilutant Temp (F)
Wind Speed
MPH
Wind Direction
Water
Herbicide/Surfactant/Adjuvant Product #/Name(s)
(EPA Registration Number in chart on back of form)
Herbicide Product Rate (Oz/Ac)
(rate applied)
Total Amount Herbicide Applied (OZ)
Total Gallons Volume Applied
(Gallons per flow meter or graduations on tank)
Total gallons
Tank beginning
Tank ending
Worker Protection Standard (WPS) Required: Yes No
Date of Contact: ________________ Time of Contact: ________________Person Contacted: ________________
Professional Applicators Signature: ___________________________________________________________
Ranger District Location/GPS Mountain Home, Lowman, Idaho City RD
Road/Area Inventory
Road Number or Name
GPS or Landmark begin
GPS or Landmark end
Number of Miles Amount of Acres Covered
Field Notes:
Product Name
EPA
Registration #
Active Ingredient
Weed Abbr.
Weed Code
Weed Name
1 Amine 4 2,4-D 34704-120 2,4-D BH HYNI Black Henbane 2 Banvel 51036-289 Dicamba CT CIAR4 Canada Thistle 3 Curtail 62719-48 Clopyralid & 2,4D CO TAVU Common Tansy 4 Escort 352-439 Metsulfuron DT LIDA Dalmatian Toadflax 5 Formula 40 2,4-D 228-357 2,4-D DK CEDI3 Diffuse Knapweed 6 Milestone 62719-519 Aminopyralid FB COAR Field Bindweed 7 Overdrive 34704NB-002 Pyridnecarboxyic HA BERTE Hoary Alyssum 8 Plateau 241-365 Imazapic HT CYOF Houndstongue 9 Platoon 228-145 2,4-D JG AECY Jointed Goatgrass 11 Redeem 62718-337 Clopyralid LS EUES Leafy Spurge 12 Roundup Original Max 524-539 Glyphosate MS SALVI Mediterranean Sage 13 Sevin XLR+ 264-333 Carbaryl MT CANU4 Musk Thistle 14 Telar XP 352-654 Chlorsulfuron OH HIERA Orange Hawkweed 15 Tordon 22 K, Outpost 22 K 62719-6 Picloram OD LEVU Oxeye Daisy 16 Transline 62719-259 Clopyralid PU TRTE Puncturevine 17 Weedar 64, 2,4-D Amine 71368-1 2,4-D RS CHJU Rush Skeltonweed 18 ST ONAC Scotch Thistle 19 SK CEMA4 Spotted Knapweed 20 WT CADR White Top 21 YT LIVU2 Yellow Toadflax
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