Att6.Pesticide_Application_Record.docx
DOCX document 26 KB Posted
- Attached to
- ROSEBURG NOXIOUS WEED TREATMENT IDIQ
- Solicitation number
- L15PS00091
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PAR
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Text version
Attachment 6 – Pesticide Application Record (PAR)
| NISIMS Chemical Treatment Record | Treatment Record ID _____________ | |
| Exact Location of Treatment Site: |
(ex:38.468218, -108.101364) Total Acres Treated
Treatment Date (ex: 6/1/2014)
Treatment Start Time (ex: 0800)
End Time (ex: 1600)
Temperature (F)
Wind Speed / Direction
Humidity
BLM PUP #
(ex: WYP070-14-003-P)
BLM Project Name
| Equipment Used (circle one) |
| TRUCK – ATV – UTV - BACKPACK – AIRPLANE - HELICOPTER – HANDHELD SPRAYER – WICK/WIPER – MOWER – TRACTOR – HORSEBACK SPRAYER |
Applicator Name/Role
Mix Diluent (circle one)
WATER – OIL - NONE
Sprayer Calibration Rate (ex: 2 GALLONS/ACRE) (circle appropriate Rate)
GALLONS/ACRE
OUNCES/ACRE
PINTS/ACRE POUNDS/ACRE
QUARTS/ACRE
| Distance to Water (circle one) |
| 0 TO 10 FEET - 10 TO 25 FEET |
25 TO 100 FEET - GT 100 FEET
Delivery Method (circle one)
| AERIAL - GROUND |
| Spray Pattern |
(circle one)
BROADCAST - SPOT
FOR SPOT APPLICATIONS ONLY
| Mix Amount Applied on Site (ex: 2 GALLONS) |
| GALLONS |
CHEMICAL BRAND(s) APPLIED - In formulated product units
| CHEMICAL BRAND NAME (ex: ROUNDUP PRO, ESCORT XP) |
| MANUFACTURER |
(ex: MONSANTO, BASF)
EPA REG #
(ex: 524-475)
RATE OF APPLICATION
Liquid ex: 2 QUARTS PER ACRE, , 8 FLUID OUNCES PER ACRE, 1 PERCENT SOLUTION Dry ex: 0.50 POUND PER ACRE, 1 OUNCE PER ACRE
ADJUVANTS BRAND(s) APPLIED - In formulated product units
| ADJUVANT BRAND NAME (ex: DYNE_AMIC) |
| MANUF |
(ex: HELENA CHEMICAL)
RATE OF APPLICATION
Liquid ex: 2 QUARTS PER ACRE, , 8 FLUID OUNCES PER ACRE, 1 PERCENT SOLUTION Dry ex: 0.50 POUND PER ACRE, 1 OUNCE PER ACRE
| Species Treated |
| PLANT PHENOLOGY (ex: Bolt, Flower, Rosette, etc.) |
| Species Code (ex: ACRE3, CADR, ONAC ) |
| Estimated Percent Cover (circle one) |
Trace (Less than 1%) – Low (1-5%) – Medium (5-25%) - High (25-100%)
Trace (Less than 1%) – Low (1-5%) – Medium (5-25%) - High (25-100%)
***If more species treated, attach another form and record there.
File details come from the government source that posted it. Updated .