Attachment_4_-_Post-Application_Documentation_Form.pdf

PDF 59 KB Posted

Attached to
Vegetation Control and Planting Services Federal contract opportunity
Solicitation number
W912ES-17-T-0115
Issued by
Department of the Army Corps of Engineers Engineering District St Paul

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Attachment 4 - Post-Application Documentation Form

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POST-APPLICATION DOCUMENTATION FORM

PEST CONTROL PROGRAM

U.S. ARMY CORPS OF ENGINEERS, ST. PAUL DISTRICT

1114 South Oak St., La Crescent MN, 55947

Ph. 651-290-5899

APPLICATION INFORMATION

APPLICATION DATE: ______________________

CONTRACTOR: _________________________________ APPLICATOR: ___________________

Addr: ___________________________________________ Addr: ___________________________

City: ____________________________________________ City: ____________________________

Phone: ___________________________________________ Phone: __________________________

TARGET PEST: ______________________________________________________________________

DATE OF TIME OF AIR RELATIVE WIND DIRECTION ACREAGE

APPLICATION DAY TEMP HUMIDITIY CLOUD COVER AND SPEED TREATED

DESCRIPTION OF TREATED AREA:

PESTICIDE INFORMATION

PESTICIDE (TRADE NAME): _________________________________________________________________________________________

FORM APPLIED: _____________________________________________________________________________________________________

ACTIVE INGREDIENTS:

EPA REGISTRATION: _____________________________________ EPA CLASSIFICATON: ______________________________________

HOW THE PESTICIDE WAS MIXED: ____________________________________________________________________________________

APPLICATION RATE (TOTAL): ________________________ APPLICATION RATE (ACTIVE) __________________________________

INGREDIENT (S) : __________________________________________________________________________________________________

APPLICATION EQUIPMENT USED:

AMOUNT APPLIED: _________________________________________________________________________________________________

DISPOSAL INFORMATION DISPOSAL DATE: ____________________________

METHOD: _________________________________________________________________________________________________________

LOCATION: _________________________________________________________________________________________________________

ADDITTIONAL REMARKS: ____________________________________________________________________________________________

APPLICATION INFORMATION
PESTICIDE INFORMATION
APPLICATION DATE:
CONTRACTOR:
APPLICATOR:
Addr:
Addr_2:
City:
City_2:
Phone:
Phone_2:
TARGET PEST:
undefined_2:
undefined_3:
undefined_4:
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DESCRIPTION OF TREATED AREA:
NAME:
FORM APPLIED:
EPA REGISTRATION:
EPA CLASSIFICATON:
HOW THE PESTICIDE WAS MIXED:
APPLICATION RATE TOTAL:
APPLICATION RATE ACTIVE:
INGREDIENT S:
APPLICATION EQUIPMENT USED:
AMOUNT APPLIED:
DISPOSAL DATE:
METHOD:
LOCATION:
ADDITTIONAL REMARKS:
ACTIVE INGREDIENTS:
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