Attachment_4_Pest_Management_Record,_15-P-0102,_20150816.pdf

Pesticide Trade Name Pesticide Active Ingredient EPA Registration # or Other # Formulation

When the pesticide information is entered below it will automatically be placed in a drop-down menu on the Data Entry worksheet. This will save time, and will avoid re-typing information for each data entry.

Click on the yellow cells below to find a description of what information is required.

Attachment 4 Pest Management Record

This sheet was designed by Chris Harding and Chris Eisner © 2003

Installation Name Dept./Office Name

Total PAI Total Survey Hours Ver 3.2, 5/30/08

Contract or In-

House

Date of Application

Inside or Outside

Facility:

Building # or

Area Operation Site Pest Area

Treated Units Applicator Name Pesticide Trade Name Pesticide Active Ingredient

EPA Registration # or Other # Formulation Quantity

Applied Units Final Conc.

(%) PAI Comments Survey Hours

Contract 05/30/2002 Inside G-15 Manual Pesticide Application Semi-Improved Grounds Broad-leaved Weeds 1 Acres Bob Jones Roundup Pro Glyphosate 524-475 Emulsion 40 Gallons 0.07 0.25 Parking Lot

UIC

Pest Management Record Directions: Fill in the installation name, department/office and UIC cells first. Next, fill in a separate row (start with Row 12) for each pest management operation. For pesticide applications, the pounds of active ingredient (PAI) will be calculated automatically based on the data you enter.

Enter pesticide information in the "Pesticide List" worksheet.

Pounds of Active Ingredient is automatically calculated.

The columns below may be titled and used to record any additional information you feel is necessary (e.g., work request #, time spent on the job, etc). You may choose to ignore these columns if you do not have additional information that you wish to record.

UIC Office Name Date of Application

In or out

Facility:

Building # or Name

Oper ation Site Pest

Area Treated

Unit s

Applicator Name

Pesticide Trade Name

Pesticide Chemical Name

EPA

Registration # or Other #

Formu lation

Quan tity

Unit s

Final Conc.

(%) PAI Comments Survey Hours