W911SA25QA048 Attachment 10 Universal Pest Management Application Reporting Form.docx
DOCX document 31 KB Posted
- Solicitation number
- W911SA25QA048
About this file
This is a Universal Pest Management Application Reporting Form template that must be completed for each pest management operation under the grounds maintenance contract for WA104 in Marysville, WA. The form requires detailed documentation of pest control activities including the date, location (indoor/outdoor), facility information, type of pest control operation, site description, target pest, and area treated measurements in specific units (SF, LF, AC, CF, or EA).
The form mandates comprehensive pesticide/herbicide application details including trade name, active ingredient, EPA registration number, formulation percentage, amount of product used with units, final concentration, and total active ingredient applied. Additional requirements include applicator information (name, signature, certification number), comments on conditions and survey results, and confirmation that a copy is sent to the 88th PMC. This form appears to be Attachment 10 of solicitation W911SA25QA048, which is for grounds maintenance services with a period of performance from March 2025 to February 2026, with four option years and a six-month extension option.
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Other files
| File | Type | Posted |
|---|---|---|
| W911SA25QA048 Attachment 6 Price Schedule_CUI.xlsx | XLSX spreadsheet | |
| W911SA25QA048 Solicitation Final.pdf | ||
| W911SA25QA048 Amendment 3 Final.pdf | ||
| W911SA25QA048 Solicitation.pdf | ||
| W911SA25QA048 Solicitation Amendment 2.pdf | ||
| W911SA25QA048 Attachment 1 PWS.docx | DOCX document | |
| W911SA25QA048 Solicitation Amendment 1.pdf | ||
| W911SA25QA048 Attachment 6 Price Schedule CUI.xlsx | XLSX spreadsheet | |
| W911SA25QA048 Solicitation Final.pdf | ||
| W911SA25QA048 Attachment 5 WD Log.xlsx | XLSX spreadsheet | |
| W911SA25QA048 Attachment 7 Drawing.pdf | ||
| W911SA25QA048 Attachment 3 PRS.xlsx | XLSX spreadsheet | |
| W911SA25Q4048 Attachment 8 DOD_Pesticides List.pdf | ||
| W911SA25QA048 Attachment 9 Service Ticket.docx | DOCX document | |
| W911SA25QA048 Attachment 4 Deliverables.docx | DOCX document | |
| W911SA25QA048 Attachment 2 AT-OPSEC.pdf | ||
| W911SA25QA048 Attachment 1 PWS.docx | DOCX document |
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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: _________________________________(percentage of AI from label) 8e. Amount of Product Used: ___________________________________________ [include unit, FL (fluid ounce), GA (gallon), ML (milliliter), LT (liter), LB (pound), DR (dry ounce), GR (gram), KG (kilogram) AND how much water was added] 8f. Final Concentration Applied: _______________________________________ [amount of ACTIVE INGREDIENT (AI) per area (examples: 1.5 oz/gal, 4lbs/1000 SF] 8g. Total Amount of Active Ingredient applied in this pest management operation: ___________________________________ [in fl oz (if liquid) or weight (if solid)]
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 .