Technical Exhibit 4_PesticideAppRecordForm.pdf
PDF 76 KB Posted
- Attached to
- Salt Creek Grounds Maintenance Federal contract opportunity
- Solicitation number
- W9128F20Q0032
About this file
This document contains a pesticide application record sheet template for the Corps of Engineers. The form requires information on the target pest, specific site description, pesticide trade name, manufacturer, EPA registration number, formulation, mixture ratio, application rate, number and timing of applications, date and time pesticide was applied, application equipment and method, applicator details, total area and amount of pesticide used, and weather conditions including wind, temperature, humidity and soil conditions. A reset button is also included.
This federal contract opportunity is for grounds maintenance services at nine Corps of Engineers lake projects in Nebraska. The contractor must provide all personnel, equipment, supplies and other items to perform mowing, trimming and vegetation control. The contractor must submit a work plan, accident prevention plan and quality control plan within 45 days of award and complete all services during the defined mowing periods. The solicitation is identified as number W9128F20Q0032 for Salt Creek Grounds Maintenance services through the Department of the Army Corps of Engineers Omaha District.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Solicitation.pdf | ||
| Technical Exhibit 5_Mowing Area Drawings 1-9.pdf |
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Text version
PESTICIDE APPLICATION RECORD SHEET
Corps of Engineers, Omaha District
ER 1130-2-540 FIELD OFFICE: DATE:
PREPARED BY: PHONE: ( )
Check one: ANTICIPATED USAGE REQUEST
ACTUAL USAGE REPORT
COMPLETE THIS SECTION FOR BOTH ANTICIPATED USAGE REQUEST AND FOR AN ACTUAL USAGE
REPORT
TARGET PEST:
SPECIFIC DESCRIPTION OF SITE(S):
PESTICIDE TRADE NAME:
MANUFACTURER:
EPA REGISTRATION NO:
EPA CLASS: GENERAL FORMULATION: LIQUID
RESTRICTED GRANULAR
PESTICIDE MIXTURE:
(if applicable) (i.e. 1 gallon/50 gallons water)
APPLICATION RATE:
(i.e. gals./sq.ft. or lbs./acre)
NUMBER & TIMING OF APPLICATIONS:
USE THIS SECTION FOR ACTUAL USAGE REPORT ONLY
DATE PESTICIDE WAS APPLIED: TIME:
APPLICATION EQUIPMENT &
METHOD OF APPLICATION:
APPLIED BY: Corps employee Contractor
NAME OF APPLICATOR:
ADDRESS:
(if contractor)
PHONE:
TOTAL AREA OF BUILDINGS TREATED:
TOTAL AMOUNT OF PESTICIDE USED:
FOR OUTSIDE APPLICATIONS:
WIND: Calm WIND DIRECTION:
0-10 mph TEMPERATURE:
10-20 mph HUMIDITY:
Other> SOIL: wet moist dry
CEMVR FORM 55-E, 01 Aug 00 (Revised) Previous editions of this form are obsolete
| FIELD OFFICE: |
| Date: |
| PREPARED BY: |
| Area Code: |
| Prep Phone #: |
| Anticipated Usage: Off |
| Actual Usage: Off |
| TARGET PEST: |
| TARGET PEST 1: |
| SPECIFIC DESCRIPTION OF SITES: |
| Specific Description 1: |
| PESTICIDE TRADE NAME: |
| MANUFACTURER: |
| EPA REGISTRATION NO: |
| General: Off |
| Restricted: Off |
| Liquid: Off |
| Granular: Off |
| PESTICIDE MIXTURE: |
| APPLICATION RATE: |
| NUMBER TIMING OF APPLICATIONS: |
| DATE PESTICIDE WAS APPLIED: |
| TIME: |
| METHOD OF APPLICATION: |
| Corps Employee: Off |
| Contractor: Off |
| NAME OF APPLICATOR: |
| Applicator ADDRESS: |
| Applicator Area Code: |
| Applicator Phone Number: |
| TOTAL AREA OF BUILDINGS TREATED: |
| TOTAL AMOUNT OF PESTICIDE USED: |
| Calm: Off |
| 0-10 mph: Off |
| 10-20 mph: Off |
| WIND DIRECTION: |
| TEMPERATURE: |
| HUMIDITY: |
| Other: Off |
| Soil: Off |
| Wet: Off |
| Moist: Off |
| Dry: Off |
| Reset Form: |
File details come from the government source that posted it. Updated .