W911SA24Q3000 Attachment 1 - 88th RD Universal Pest Management Application Reporting Form.docx

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Grounds Maintenance Services at KS083 Hays, KS
Solicitation number
W911SA24Q3000
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This document contains a universal pest management application reporting form. The form requires information such as the date, location, type of pest control operation, site description, pest targeted, area treated, name of applicator, pesticide or herbicide used including trade name, active ingredient, EPA registration number, formulation, and quantity applied. It also includes fields for comments on survey results, wind conditions, sanitation deficiencies, and the signature of the applicator and their certification number. A copy of the completed form is to be sent to the 88th Pest Management Coordinator.

The related federal contract opportunity is solicitation number W911SA24Q3000 for grounds maintenance services at Fort McCoy in Hays, Kansas issued by the Department of the Army Materiel Command Mission and Installation Contracting Command.

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Other files

File Type Posted
W911SA24Q3000 Attachment 2 - KS083 Grounds Price Schedule CUI.xlsx XLSX spreadsheet
W911SA24Q3000 Solicitation.pdf PDF
W911SA24Q3000 Attachment 5 - Sample Grounds Service Ticket.docx DOCX document
W911SA24Q3000 Attachment 4 - KS083 Grounds AT-OPSEC.pdf PDF
W911SA24Q3000 Attachment 3 - KS083 Grounds Map.pdf PDF

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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 .