W911SA-24-Q-3001 Attachment 5 - 88th RD Universal Pest Management Application Reporting Form.docx
DOCX document 28 KB Posted
- Solicitation number
- W911SA-24-Q-3001
About this file
This document contains a universal pest management application reporting form and details of a related federal contract opportunity for grounds maintenance services. The reporting form requires contractors to provide details of each pest management operation such as date, location, type of pest control used, area and pests treated, pesticides applied, and signature of the applicator. The related federal contract opportunity is a solicitation issued by the Department of the Army Materiel Command Mission and Installation Contracting Command Fort McCoy to provide grounds maintenance services at multiple facilities in New Century, Kansas. Contractors are requested to provide quotes for these services.
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Other files
| File | Type | Posted |
|---|---|---|
| W911SA-24-Q-3001 Attachment 4 - Sample Service Ticket.docx | DOCX document | |
| W911SA-24-Q-3001 Attachment 1 - Price Schedule - CUI.xlsx | XLSX spreadsheet | |
| W911SA-24-Q-3001 Attachment 2 - Facility Drawings.pdf | ||
| W911SA-24-Q-3001 - 1449 Solicitation.pdf | ||
| W911SA-24-Q-3001 Attachment 3 - AT OPSEC.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)____________
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