Pesticide_Application_Record_Template.docx
DOCX document 34 KB Posted
- Attached to
- GOSHUTES 2025 FUELS REDUCTION TREATMENT
- Solicitation number
- 140L3925Q0050
About this file
The document is a Pesticide Application Record (PAR) template for the Bureau of Land Management's Elko District, designed to comprehensively document pesticide application details for a fuels reduction treatment project. The template requires detailed tracking of application conditions, including weather parameters, applicator information, equipment used, chemical brands, application rates, and species information.
The associated federal contract opportunity (Solicitation Number: 140L3925Q0050) involves a Goshutes 2025 Fuels Reduction Treatment spanning 1,971 acres, comprising 1,919 acres of uplands and 52 acres of potential wetlands. The project is managed by the Department of the Interior's Bureau of Land Management Nevada Region. The PAR template lists 13 specific Pesticide Use Proposal (PUP) numbers for chemicals such as 2,4-D, Aminopyralid, Glyphosate, and Triclopyr, with a requirement that application records must be completed within 24 hours of pesticide application and retained for a minimum of 10 years.
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Text version
| GROUND - Pesticide Application Record (PAR) | Contract or Agreement Number:________________________ |
| Bureau of Land Management Elko District | BLM Project Name: __________________________________ |
| 3900 Idaho St Elko, NV 89801 | Company Name: ______________________________________ |
| TREATMENT INFORMATION |
Date (ex: 6/1/2014) BLM PUP # (Refer to page 2 for a list)
Weather Reading time (START):
| Temperature °F: |
| RH %: |
| Wind Direction: |
| Wind Max mph: |
| Wind Avg mph: |
Weather Reading time (STOP):
| Temperature °F: |
| RH %: |
| Wind Direction: |
| Wind Max mph: |
| Wind Avg mph: |
Licensed Applicator Name, License Number AND Crew Members
Mix Diluent (circle one)
WATER
OIL
NONE
Equipment Used (circle one) TRUCK – ATV – UTV - BACKPACK – AIRPLANE - HELICOPTER – HANDHELD SPRAYER – WICK/WIPER – MOWER
TRACTOR – HORSEBACK SPRAYER
Sprayer Calibration Rate (ex: 2 GALLONS/ACRE) (circle appropriate Rate)
GALLONS/ACRE
POUNDS/ACRE
Distance to Water (circle one)
0 TO 10 FEET
10 TO 25 FEET
25 TO 100 FEET
GREATER THAN 100 FEET
Delivery Method (circle one)
| AERIAL – GROUND |
| Spray Pattern |
(circle one)
BROADCAST – SPOT
Mix Amount Applied on Site (ex: 2 GALLONS)
Total Acres Treated: (ex: 40 ACRES)
Swath Width of Equipment (Broadcast Only) (ex: 50 FEET; NA for SPOT)
FOR LINEAR FEATURES ONLY (i.e. road or stream)
Buffer Width
| Buffer Width Units |
| FEET |
| Buffer Direction |
| LEFT - CENTER - RIGHT |
Note on Buffer Direction: left or right will buffer in only one direction, while center will buffer both sides based on the width and units provided. For instance a right buffer of 10 feet will buffer 10 feet on the right only while a center buffer of 10 feet will buffer both sides of the centerline (total buffer is 20 feet)
CHEMICAL BRAND(s) APPLIED - In formulated product units
| CHEMICAL TRADE NAME (ex: Roundup Pro, Overdrive) |
| MANUFACTURER |
(ex: MONSANTO, BASF)
EPA REG #
(ex: 524-475, 7969-150)
CHEMICAL
COMMON NAME
(ex: Glyphosate, Dicamba + Diflufenzopyr)
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) |
| MANUFACTURER |
(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
Per BLM policy, Pesticide Application Records must be completed within 24 hours of pesticide application and are kept for a minimum of 10 years.
Associated Shapefile(s)/Tracklog(s) File ID: (ex: CraneSprings06052020_01)
SPECIES INFORMATION
SPECIES COMMON NAME
(ex. Russian Knapweed)
PLANT PHENOLOGY
(circle one)
ESTIMATED PERCENT COVER
(1 -100%)
BARE GROUND – BOLT – BUD DORMANT – FLOWER MATURE – PRE-BUD ROSETTE – SEED SET SCENESCENT – VEGETATIVE
BARE GROUND – BOLT – BUD DORMANT – FLOWER MATURE – PRE-BUD ROSETTE – SEED SET SCENESCENT – VEGETATIVE
BARE GROUND – BOLT – BUD DORMANT – FLOWER MATURE – PRE-BUD ROSETTE – SEED SET SCENESCENT – VEGETATIVE
BARE GROUND – BOLT – BUD DORMANT – FLOWER MATURE – PRE-BUD ROSETTE – SEED SET SCENESCENT – VEGETATIVE
Elko District Pesticide Use Proposal (PUP) Numbers:
NVE000-25-001-P =2,4-D
NVE000-25-002-P = Aminopyralid NVE000-25-003-P = Chlorsulfuron NVE000-25-004-P =Clopyralid NVE000-25-005-P =Dicamba NVE000-25-006-P =Glyphosate NVE000-25-007-P =Imazapic NVE000-25-008-P =Imazapyr NVE000-25-009-P =Indaziflam NVE000-25-010-P =Metsulfuron Methyl NVE000-25-011-P =Picloram NVE000-25-012-P =Rimsulfuron NVE000-25-013-P =Triclopyr
Notes
Per BLM policy, Pesticide Application Records must be completed within 24 hours of pesticide application.
File details come from the government source that posted it. Updated .