W911SA22Q3029 Attachment 6 (Universal Pest Management Form).docx
DOCX document 22 KB Posted
- Attached to
- Grounds Services Multi-site UT034; UT010 & UT032 Federal contract opportunity
- Solicitation number
- W911SA22Q3029
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| W911SA22Q3029 Attachment 3 (UT032 Drawing) updated.pdf | ||
| W911SA22Q3029 Amendment 1.pdf | ||
| W911SA22Q3029 Attachment 5 (Grounds Sample Service Ticket).docx | DOCX document | |
| W911SA22Q3029 Solicitation.pdf | ||
| W911SA22Q3029 Attachment 4 (AT OPSEC) CUI.pdf | ||
| W911SA22Q3029 Attachment 1 (Price Schedule -blank) CUI.xlsx | XLSX spreadsheet | |
| W911SA22Q3029 Attachment 2 (UT010 Drawing).pdf | ||
| W911SA22Q3029 Attachment 3 (UT032 Drawing).pdf |
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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 .