W912ES23Q0082 Att 03 Post-Application Documentation Form.pdf
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- Solicitation number
- W912ES23Q0082
About this file
This document contains a post-application documentation form and information on a related federal contract opportunity for tree planting and vegetation control services. The post-application form collects details on pest control applications made at U.S. Army Corps of Engineers facilities in La Crescent, Minnesota, including the target pest, date and time of application, weather conditions, acreage treated, pesticide used, application rates and equipment, and disposal information. The related federal contract opportunity is solicited by the Department of the Army Corps of Engineers Engineering District St Paul for tree planting and vegetation control services to support restoration efforts at McGregor Lake in Crawford County, Wisconsin.
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Text version
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: |
| undefined_5: |
| undefined_6: |
| 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: |
| undefined: |
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