W911SA-18-Q-3035_Attachment_4_Grounds_Weed_Control_Form.docx

DOCX document 28 KB Posted

Attached to
Grounds Services UT007- Ogden, UT Federal contract opportunity
Solicitation number
W911SA-18-Q-3035
Issued by
Department of the Army Materiel Command Mission and Installation Contracting Command Fort McCoy

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Attachment 4 Weed Control Form

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W911SA-18-Q-3035_Attachment_2_UT007_Grounds_Drawing.docx DOCX document
W911SA-18-Q-3035_Attachment_1_OPSEC.pdf PDF
W911SA-18-Q-3035_Attachment_3_Grounds_Service_Ticket.docx DOCX document
W911SA-18-Q-3035_Solicitation.docx DOCX document
W911SA-18-Q-3035_Attachment_5_Price_Schedule.xlsx XLSX spreadsheet

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88th RSC

WEED CONTROL RECORD FORM

Version 1.3; 29 Jun 2017 A separate form shall be filled out for each operation.

Please print for number 1-8.

1. Date of Application: _________________________

2. Facility Name: ____________________________

3. Type of Application: ________________________________________ (e.g., power spray, manual application etc.)

4. Site Description: ______________________________________ (e.g. lawn, unimproved ground, fence line, parking lot cracks, etc.)

5. Size of Area Treated: _________________________________ [Include unit, SF (square feet), LF (linear feet), AC (acre), CF (cubic feet)]

6. Applicator’s Name: ___________________________________

7. Herbicide Used:

7a. Herbicide Trade Name: ___________________________________

7b. Herbicide Active Ingredient: ________________________________________

7c. EPA or State Reg # : ________________________________

7d. Formulation: _____________________________________

7d. Quantity of herbicide applied ____________________________ [(include unit, FL (fluid ounce), GA (gallon), ML (milliliter), LT (liter), LB (pound), DR (dry ounce), GR (gram), KG (kilogram)]

7e. Final Concentration Applied (%): _______________________________

8. Additional Comments: (survey results, wind conditions, sanitation deficiencies, etc.)

9. Signature of Applicator: ___________________________________

10. Certification # of Applicator: _______________________________

11. (PWS #5.3.5) Copy of this form attached to invoice in iRAPT on (date): ___________________ Version 1.3 29 JUN 2017

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