W911SA24Q3128 Attachment 5 - 88th RD Universal Pest Management Application Reporting Form.docx
DOCX document 31 KB Posted
- Solicitation number
- W911SA24Q3128
About this file
This document is a Universal Pest Management Application Reporting Form for the 88th Readiness Division. It is used to record details of each pest management operation, including the date, location, type of pest control, area treated, pesticides used, and the applicator's information. The form collects key details such as the pest type, pesticide trade name and active ingredient, EPA registration number, quantity applied, and final concentration. It also provides space for comments on survey results, wind conditions, and sanitation deficiencies. This form supports the federal contract opportunity W911SA24Q3128 for Grounds Maintenance Services at WA035 in Tacoma, WA, which is a Request for Quotes issued by the Department of the Army Materiel Command Mission and Installation Contracting Command Fort McCoy.
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Other files
| File | Type | Posted |
|---|---|---|
| W911SA24Q3128 Attachment 2 - AT OPSEC.pdf | ||
| W911SA24Q3128 Attachment 1 - Price Schedule - CUI.xlsx | XLSX spreadsheet | |
| W911SA24Q3128 Attachment 3 - Drawing.pdf | ||
| W911SA24Q3128 Attachment 4 - Service Ticket.docx | DOCX document | |
| W911SA24Q3128 Solicitiation.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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