W911SA-24-Q-3088 - Attachment 2 -Universal Pest Management Application Reporting Form.docx
DOCX document 28 KB Posted
- Attached to
- Grounds Maintenance at KS104 Dodge City KS
- Solicitation number
- W911SA-24-Q-3088
About this file
This document contains a universal pest management application reporting form and information about a related federal contract opportunity for grounds maintenance services. The reporting form requires applicants to provide details about each pest management operation such as the date, location, type of control operation used, site description, pest targeted, area treated, name of the applicator, pesticide or herbicide used including trade name, active ingredient, EPA registration number, formulation, and quantity applied. It also includes fields for comments and the signature and certification number of the applicator. The related federal contract opportunity is solicitation number W911SA-24-Q-3088 from the Department of the Army Materiel Command Mission and Installation Contracting Command Fort McCoy for grounds maintenance services at Dodge City, Kansas.
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Other files
| File | Type | Posted |
|---|---|---|
| W911SA-24-Q-3088 - Attachment 3 - Drawing.pdf | ||
| W911SA-24-Q-3088 SOL Released.pdf | ||
| W911SA-24-Q-3088 - Attachment 5 - Service Ticket.docx | DOCX document | |
| W911SA-24-Q-3088 - Attachment 4 - AT-OPSEC.pdf | ||
| W911SA-24-Q-3088 - Attachment 1 - Price Schedule CUI (blank).xlsx | XLSX spreadsheet |
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Text version
88th Readiness Division
UNIVERSAL PEST MANAGEMENT APPLICATION REPORTING FORM
A separate form shall be filled out for each pest management operation.
Please print for number 1-9.
1. Date of Application: _________________________
2. Location: 2a. Inside or Outside (circle one) 2b. Facility name and/or building #: _______________________________________
3. Type of Pest Control Operation: ______________________________________________ (e.g., baiting, power spray, ULV, manual application of pesticide etc.)
4. Site Description: ______________________________________ (e.g., office, lawn, unimproved ground, fence line, parking lot cracks, etc.)
5. Pest: _________________________________________(rodents, spiders, nates, weeds, etc.)
6. Area Treated: _________________________________ [Include unit, SF (square feet), LF (linear feet), AC (acre), CF (cubic feet), EA (each - for baiting only)]
7. Applicator’s Name: ___________________________________
8. Pesticide/Herbicide Used:
8a. Pesticide/Herbicide Trade Name: _______________________________________ 8b. Pesticide/Herbicide Active Ingredient: ___________________________________ 8c. EPA or Country Reg #: ________________________________________________ 8d. Formulation: _________________________________________________________ 8d. Quantity of pesticide applied: ___________________________________________ [include unit, FL (fluid ounce), GA (gallon), ML (milliliter), LT (liter), LB (pound), DR (dry ounce), GR (gram), KG (kilogram)] 8e. Final Concentration Applied: _______________________________________ (amount of active ingredient per acre/area)
9. Comments: (survey results, wind conditions, sanitation deficiencies, etc.)
10. Signature of Applicator: ____________________________________________
11. Certification # of Applicator: _________________________________________
12. Copy sent to 88th PMC on (date)____________
File details come from the government source that posted it. Updated .