PSI Invasives Treatment IDIQ Attach 04 Daily_Application_Record.pdf

USDA Forest Service Attachment 02

Pike/San Isabel National Forests

Daily Pesticide Application Record

Ranger District: ____________________________ Date: ____________

Location of Application Drainage: _________________________ Specific Location: _____________________ Township: ________ Range: ______ Section(s): ____________________________ Township: ________ Range: ______ Section(s): ____________________________ Township: ________ Range: ______ Section(s): ____________________________

Land Ownership: FS___BLM___State___PVT___Other___________

Job Code: _______________

Application Information Time: Start _______ End _______ Start _______ End _______

Initial Treatment _____ Re-treatment _____ Weather Conditions: Clear _____ Cloudy ______ Partly Cloudy _____

Wind Speed: ________mph, from __________ Temperature _________ ** Calibration/Maintenance of Equipment Y/N_______

**In/Over Water Y/N____ **Near Water Y/N____ (below seasonal floodplain) **Treatment Monitoring Comments: (negative impacts observed?) ______________________________

Target Weeds (List most abundant weed first)

Stage of Growth: Bud _____ Flowering _____Seeding _____

Site of Application:

Rangeland___ Campground___ Trailhead___ Right of Way___ Other______________

Herbicides Used:

Name: __________________ EPA number: _________________ Rate (AI) per acre: _______ Name: __________________ EPA number: _________________ Rate (AI) per acre: _______ Name: __________________ EPA number: _________________ Rate (AI) per acre: _______ Name: __________________ EPA number: _________________ Rate (AI) per acre: _______

Dilutant Used: ________ Gallons per Acre: ______ Total Gallons Mix applied: ______

Application Method: ____________________Calibrated Acres Treated: __________

Empty Containers Triple Rinsed: Yes _____ No _____ Disposal Site: ________________________________

Affected Acres Treated: ________ Affected Acreage Justification/Comments: _______________________________________________________

Applicator’s Signature: _________________________________________________

Certified Applicator’s Signature: __________________________________________