04f_DWA Weed Treatment 2020 - PWS Att6 Application Record.pdf

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PEST CONTROL APPLICATION RECORD - Operations

ATTENTION: This record must be completed the same day as the application, and aseparate record completed for each pest control category or change in formulation. Itmust be forwarded within 7 days to the assigned Corps of Engineers Pest Manager.

Page of NWW Form 1001-O, Sep 2018 Page of NWW Form 1001-O, Mar 2017

1. Pesticide Application Sponsor

2. Licensed Pest Applicator Alternate Pest Applicator (if applicable) Trade Name Active Ingredient (AI) Pounds of AI Pesticide Classification EPA Registration No.

State Permit Required State Permit No.

Biological Controls Release Count Mechanical Controls Manual Controls

4. Pest Management Application *Date *Start Time (HHMM) *Stop Time (HHMM) *Acres *Wind Direction *Wind Speed (mph) *Temperature (F) *Treatment Tool *Platform *License Plate *Medium

5. GPS Coordinates (WGS84, Decimal Degrees) of Application *Longitude (nnn.nnnnn) *Latitude (nn.nnnnn) *Application Radius (ft)

6. Target Species *Pest Category *Pest Name *Number of Pests Treated

INSTRUCTIONS

Pest Control Application Record Notes:

- Fields with an asterisk (*) are mandatory.

- Selecting 'Other' in any field requires supplemental information in the Comments field.

- The 'Reset all but Applicator Data' button may be used to clear the record while preserving applicator information.

- The 'Email Data' button may be used to return record data to the assigned Corps of Engineers Pest Manager.

1. Pesticide Application Sponsor: Include contact information for the entity sponsoring the application.

- For "Telephone", enter ten digits without any special characters (,),-, etc.

2. Licensed Pest Applicator: Include contact and license information for the individual performing the application.

Alternate Pest Applicator (if applicable): Enter the alternate licensed pest applicator's information.

3. Pest Control Category: Select a general category of pest control. Changing categories requires an additional form.

Chemical Control (if applicable): If applying a mixture of chemicals, use the 'Add Row' and 'Delete Row' buttons as required to describe all chemicals in the mixture. Changing mixtures requires an additional form. The trade name is found on the pesticide label including adjuvants (buffer, spreader, sticker, surfactant) etc.). EPA Registration Number: If the material is being applied under a federal experimental use permit and no EPA Reg. No. exists, list the federal experimental use permit number.

Biological, Mechanical, Manual Control (if applicable): select the control used.

4. Pest Management Application: Indicate the direction from which the wind is blowing. Measure wind velocity in mph. If the wind varies in direction and velocity during the application, indicate the prevailing conditions. Wind readings shall be obtained in close proximity to the application site. Indicate average temperature in degrees Fahrenheit. Temperature readings shall be obtained in close proximity to the application site.

5. GPS Coordinates (WGS84, Decimal Degrees) of Application: Taken from hand-held GPS unit at the time of application. The location of an application is collected as a point, requiring a single latitude-longitude pair at the center of the application. Enter position information to at least the forth decimal place (46.0001). For each application, estimate a radius to the edge of the treated area. See graphic below for examples.

6. Target Species: Describe the pest that is being controlled.

PRIVACY ACT STATEMENT

AUTHORITY: Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a), and applicable regulations. Engineer Regulation 1130-2-540, Chapter 3 (Pest Control Program for Civil Works Projects).

PRINCIPLE PURPOSE(S): Collection of required data on actual and anticipated use of pesticides on federal lands managed by the U.S. Army Corps of Engineers, Walla Walla District.

ROUTINE USES: The privacy information on this form will be used only by the Walla Walla District of the U.S. Army Corps of Engineers and authorized staff. Such information is protected by the Privacy Act of 1974 and will not be released without the reporting party's consent.

DISCLOSURE: Voluntary; however, failure to provide personal information may not comply with applicable state/local reporting requirements.

8.2.1.4029.1.523496.503679 NWW_pest_mgmt_reports@usace.army.mil USACE NWW District Pest Control Application Record