Go_no_Go_Spray_checklist_AF.pdf

GO-NO-GO PESTICIDE APPLICATION CHECKLIST

Before any pesticide application begins the following questions must be answered. If any question is answered with a no, then the application is prohibited from occurring. This form must be filled out and signed before the application begins and turned in daily.

Yes___ No____ The applicator has read and understands the entire pesticide label? FIFRA Section 2(ee)

Yes___ No____ The pesticide label and M.S.D.S. are in the possession of the applicator? CCR 6602

Yes___ No____ All persons applying pesticides or working in the area of the application have received safety training?

(NPS Pesticide Applicator Safety Class) CCR 6700, 6720, 6724

Yes___ No____ The applicator has the Pest Control Recommendation on site? CCR 6632

Yes___ No____ Pesticide spill kit is on site? CCR 6738

Yes___ No____ Pesticide decontamination kit is on site? CCR 6734

Yes___ No____ Emergency contact list is on site? CCR6700, 6720

Yes___ No____ The site has been posted and interested parties notified that a pesticide application will be occurring?

FAC Section 12978

Yes___ No____ A plan is in place to keep unprotected workers and animals out of the treatment area until dry? CCR6614 Describe______________________________________________________________________

Yes___ No___ There is no potential for herbicide to drift and contact workers or other persons, wildlife or animals?

CCR 6614, 6600 (D), and (E)

Yes___ No___ Checked local weather forecast. No precipitation expected within the next 24 hours? CCR 6600(b) 6600(d)

Yes___ No___ If application is occurring in sensitive areas (close to residential areas, bodies of water, non-target plants or T&E species) the wind is blowing away from sensitive areas and there is minimal chance of drift? CCR6600

Yes___ No___ The wind speed is below 7 mph and is blowing in a constant direction? CCR6614, 6720, 6600 (d) (e), FAC12973

Yes___ No___ The temperature is below 80 degrees Fahrenheit? FAC12973, CCR 6600(e), 6614, FIFRASec2 (ee), Yes___ No___ The relative humidity is above 35%? FAC 12973, CCR6600 (d) (e), FIFRA Sec 2(ee)

Yes___ No___ The soil temperature is less than 15 degrees above air temperature? FIFRA Sec 2(ee), CCR6600 (d) (e)

Yes___ No___ There is no temperature inversion present? FIFRA Sec 2(ee), CCR600 (d) (e), 6614, FAC 12972, 12973

Yes___ No___ Applicator is familiar with local wind patterns and how they affect spray drift? FIFRA Sec2 (ee)

Yes___ No___ There is no moisture on plant leaves or bark? FIFRA Sec 2(ee)

Yes___ No____ Fog is not present in the treatment area? FIFRA Sec 2 (ee)

Yes___ No___ Application equipment has been calibrated and in good working order? FIFRA Sec 2 (ee), CCR 6600(a), 6742

Under penalty of law, I certify that all the above questions were accurately answered and answered “YES.”

Signature____________________________ Name (Print) _______________________________Date_____________

List all persons working on this herbicide application. 1) ___________________________2) _______________________

3______________________________4) ______________________________5) _________________________________

6) _____________________________7) _______________________________8) ________________________________

Location of application_______________________________________________________________________________

Start time of application_________________ Time spraying was completed___________

Wind direction at start of application_______ Wind direction at end of application________

Weather readings for each hour on site or more frequently if change in weather:

Time ___________ Wind Speed_____ (mph) Temperature______ (F) Humidity_____ Reading taken by_____________

Time___________ Wind Speed____ (mph) Temperature______ (F) Humidity______ Reading taken by____________

Time___________ Wind Speed_____ (mph) Temperature______ (F) Humidity______ Reading taken by____________

Time___________ Wind Speed______ (mph) Temperature______ (F) Humidity______ Reading taken by____________

Time___________ Wind Speed______ (mph) Temperature______ (F) Humidity______ Reading taken by____________

Time___________ Wind Speed______ (mph) Temperature______ (F) Humidity______ Reading taken by____________

Time___________ Wind Speed______ (mph) Temperature______ (F) Humidity______ Reading taken by____________

Time___________ Wind Speed______ (mph) Temperature______ (F) Humidity______ Reading taken by____________

Notes_____________________________________________________________________________________________

Under penalty of law I certify that the above listed information is true and correct.

Signature_________________________________ Name and title (print) _______________________________________

Date_______________________________

This form (both sides) must be completed for each day and/ or site. This form is to be used by anyone applying herbicides on park property (contractor, volunteer, park staff etc). The completed form is to be faxed to (415) 441-6538 or hand delivered to Golden Gate National Recreation Area IPM Coordinator at the end of each work day.