Attachment - MRPO PesticideAppRecord.pdf
PDF 76 KB Posted
- Attached to
- Landscaping and Ground Maintenance Services Federal contract opportunity
- Solicitation number
- W9128F25Q0014
About this file
This is a pesticide application record sheet form (CEMVR Form 55-E) used by the Corps of Engineers, Omaha District under ER 1130-2-540. The form serves two purposes: documenting anticipated pesticide usage requests and recording actual pesticide applications.
The form requires detailed information including target pest identification, site descriptions, pesticide specifications (trade name, manufacturer, EPA registration, classification as general or restricted, and formulation type), mixture ratios, and application rates. For actual usage reporting, additional fields capture application date/time, equipment used, applicator details (Corps employee or contractor), total area treated, amount used, and environmental conditions during outdoor applications (wind speed/direction, temperature, humidity, and soil moisture). This template appears to be a standard form for tracking and documenting pesticide applications at Corps facilities.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amd 02 for W9128F25Q0014 - MRPO Grounds Maintenance.pdf | ||
| Questions and Answers for W9128F25Q0014 Updated 20250227.pdf | ||
| Attendance List - Site Visit Sign in Sheet.pdf | ||
| 7.4 MRPO PesticideAppRecord.pdf | ||
| 7.6 MRPO Groundkeeping Plan.pdf | ||
| Questions and Answers for W9128F25Q0014.pdf | ||
| 7.8 Landscape replacement..pdf | ||
| W9128F25Q0014 - MRPO Grounds Maintenance_r1.pdf | ||
| Amd 01 for W9128F25Q0014 - MRPO Grounds Maintenance.pdf | ||
| W9128F25Q0014 - MRPO Grounds Maintenance.pdf | ||
| Attachment - MAP - MRPO Groundkeeping Plan.pdf |
Show all 11
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
PESTICIDE APPLICATION RECORD SHEET
Corps of Engineers, Omaha District
ER 1130-2-540 FIELD OFFICE: DATE:
PREPARED BY: PHONE: ( )
Check one: ANTICIPATED USAGE REQUEST
ACTUAL USAGE REPORT
COMPLETE THIS SECTION FOR BOTH ANTICIPATED USAGE REQUEST AND FOR AN ACTUAL USAGE
REPORT
TARGET PEST:
SPECIFIC DESCRIPTION OF SITE(S):
PESTICIDE TRADE NAME:
MANUFACTURER:
EPA REGISTRATION NO:
EPA CLASS: GENERAL FORMULATION: LIQUID
RESTRICTED GRANULAR
PESTICIDE MIXTURE:
(if applicable) (i.e. 1 gallon/50 gallons water)
APPLICATION RATE:
(i.e. gals./sq.ft. or lbs./acre)
NUMBER & TIMING OF APPLICATIONS:
USE THIS SECTION FOR ACTUAL USAGE REPORT ONLY
DATE PESTICIDE WAS APPLIED: TIME:
APPLICATION EQUIPMENT &
METHOD OF APPLICATION:
APPLIED BY: Corps employee Contractor
NAME OF APPLICATOR:
ADDRESS:
(if contractor)
PHONE:
TOTAL AREA OF BUILDINGS TREATED:
TOTAL AMOUNT OF PESTICIDE USED:
FOR OUTSIDE APPLICATIONS:
WIND: Calm WIND DIRECTION:
0-10 mph TEMPERATURE:
10-20 mph HUMIDITY:
Other> SOIL: wet moist dry
CEMVR FORM 55-E, 01 Aug 00 (Revised) Previous editions of this form are obsolete
| FIELD OFFICE: |
| Date: |
| PREPARED BY: |
| Area Code: |
| Prep Phone #: |
| Anticipated Usage: Off |
| Actual Usage: Off |
| TARGET PEST: |
| TARGET PEST 1: |
| SPECIFIC DESCRIPTION OF SITES: |
| Specific Description 1: |
| PESTICIDE TRADE NAME: |
| MANUFACTURER: |
| EPA REGISTRATION NO: |
| General: Off |
| Restricted: Off |
| Liquid: Off |
| Granular: Off |
| PESTICIDE MIXTURE: |
| APPLICATION RATE: |
| NUMBER TIMING OF APPLICATIONS: |
| DATE PESTICIDE WAS APPLIED: |
| TIME: |
| METHOD OF APPLICATION: |
| Corps Employee: Off |
| Contractor: Off |
| NAME OF APPLICATOR: |
| Applicator ADDRESS: |
| Applicator Area Code: |
| Applicator Phone Number: |
| TOTAL AREA OF BUILDINGS TREATED: |
| TOTAL AMOUNT OF PESTICIDE USED: |
| Calm: Off |
| 0-10 mph: Off |
| 10-20 mph: Off |
| WIND DIRECTION: |
| TEMPERATURE: |
| HUMIDITY: |
| Other: Off |
| Soil: Off |
| Wet: Off |
| Moist: Off |
| Dry: Off |
| Reset Form: |
File details come from the government source that posted it. Updated .