W911SA24Q3135 Attachment 5 - Pest Management Record FY24.pdf

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W911SA24Q3135 Pest Control Services for Region 6 in California
Solicitation number
W911SA24Q3135
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This document is a Pest Management Record form for the 63rd Readiness Division. It is used to track details of pesticide applications, including the date, location, type of pest control, target pest, pesticide information, application details, applicator information, and approvals.

The related federal contract opportunity is a Request for Quotes (RFQ) for Pest Control Services for Region 6 in California, solicitation number W911SA24Q3135, issued by the Department of the Army Materiel Command Mission and Installation Contracting Command Fort McCoy. The RFQ is seeking pest control services, but the key details about the required products/services, response dates, award information, and other salient contract terms are not provided in the given documentation.

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Other files

File Type Posted
W911SA24Q3135 Solicitation.pdf PDF
W911SA24Q3135 Attachment 3 - AT OPSEC.pdf PDF
W911SA24Q3135 Attachment 2 - Drawings.pdf PDF
W911SA24Q3135 Attachment 4 - FY22 Pesticide Use List 63d RD.pdf PDF
W911SA24Q3135 Attachment 7 - Wage Determinations.xlsx XLSX spreadsheet

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63d Readiness Division Contracted Pest Management Record

01OCT2020

Email COMPLETED copy to: 63d RD, Environmental Division:

usarmy.usarc.63-rsc.mbx.integrated-pest-management@mail.mil

A separate form MUST be filled out for EACH TYPE of pesticide applied.

1. Date of Application: ___________________________________________________________

2. Location (choose ONE): Outside Inside Building #(s):______________________

3. Type of Pest Control (choose ONE):

Baiting Set/Service Traps Manual Application Power Pesticide Application Surveillance Other: __________________________

4. Site Description (choose ONE):

Family Housing Unimproved Grounds Industrial Facilities Warehouse (non-food storage) Lawns Other: __________________________ Office/Administration Areas

5. Target Pest (Do Not Write “General”):_____________________________________________

6. Total Area Treated:

________Acres _________________Square Feet ______Each (total # of bait stations/traps)

7. Applicator Name (printed):______________________________________________________

8. Pesticide Name (REQUIRED): __________________________________________________

9. Percent Active Ingredient % (Per label):___________________________________________

10. EPA Registration (REQUIRED) #: _______________________________________________

11. Formulation:

Aerosol Solution Dust/Granule Emulsion Bait Suspension

12. Total Quantity Applied (REQUIRED):

_________Fluid Ounces ______Gallons ______Pounds ______Dry Ounces ______Grams

13. Final Concentration % (REQUIRED):_____________________________________________

14. Facility Name and Facility ID Number: ____________________________________________

15. Applicator Signature: _________________________________________________________

Applicator License #:_________________________ Expiration Date:_______________

16. Company: __________________________________ Phone: _________________________

Address: ______________________________________________________________

17. 63d RD Approval Signature: ________________________________Date:_______________

Printed Name: __________________________________________________________ mailto:usarmy.usarc.63-rsc.mbx.integrated-pest-management@mail.mil

File details come from the government source that posted it. Updated .