ATTACHMENT_B_-_W912ES19T0034.doc
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- W912ES19T0034
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Attachment B - Post-Application Form
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ATTACHMENT B
ST PAUL DISTRICT
DATE: _____________________
U.S. ARMY CORPS OF ENGINEERS
Address: ___________________________
PEST CONTROL PROGRAM
City: ______________________________
POST-APPLICATION DOCUMENTATION FORM
Phn: ______________________________
CONTRACTOR: ___________________________ APPLICATOR: _____________________________
Addr: ____________________________________ Addr: _____________________________________
City: ____________________________________ City: _____________________________________
Phone:____________________________________ Phone:_____________________________________
TARGET PEST: _________________________________________________________
DATE OF TIME OF AIR RELATIVE
WIND DIRECTION ACREAGE
APPLICAT DAY TEMP HUMIDITY CLOUD COVER AND SPEED
TREATED*
DESCRIPTION OF TREATED AREA: _____________________________________________________
PESTICIDE (TRADE NAME): ___________________________________________________________
FORM APPLIED: ______________________________________________________________________
ACTIVE INGREDIENTS: _______________________________________________________________
EPA REGISTRATION: ______________________ EPA CLASSIFICATION: _____________________
HOW THE PESTICIDE WAS MIXED: _____________________________________________________
APPLICATION RATE (TOTAL): ______________________ APPLICATION RATE [ACTIVE
INGREDIENT(S)]: _____________________________________________________________________
APPLICATION EQUIPMENT USED: _____________________________________________________
AMOUNT APPLIED: ___________________________________________________________________
DISPOSAL INFORMATION
DISPOSAL DATE: ___________
METHOD: ____________________________________________________________________________
LOCATION: __________________________________________________________________________
ADDITIONAL REMARKS: ______________________________________________________________
* If the site is spot treated, estimate only actual acreage treated.
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