Attachment 0003 - Post-Application Documentation Form.pdf

PDF 59 KB Posted

Attached to
Reed canary-grass Control on the Sturgeon Lake Tribal Partnership Program Island Rehabilitation Project
Solicitation number
W912ES25QA016
Issued by

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The document is a Post-Application Documentation Form for a Pest Control Program used by the U.S. Army Corps of Engineers, St. Paul District. The form is designed to capture detailed information about a specific pest control application, including contractor and applicator details, target pest, application conditions (date, time, temperature, humidity, wind direction), and treated area description. The second page of the form collects comprehensive pesticide information such as trade name, active ingredients, EPA registration, mixing method, application rates, equipment used, disposal details, and additional remarks.

This form appears to be a standardized documentation template for tracking and recording pest control treatments, providing a systematic approach to logging critical environmental and operational data for each pest management intervention. The form's structure ensures thorough documentation of the pest control process, which is likely important for regulatory compliance, environmental monitoring, and maintaining accurate records of pest management activities.

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Other files

File Type Posted
Attachment 0001 - Project Area Maps - Amendment 0002.pdf PDF
W912ES25QA016 0002 Amendment 0002.pdf PDF
W912ES25QA016 Schedule of Services - Amendment 0002.xlsx XLSX spreadsheet
Amendment 0002 - 25QA016 SOW Sturgeon Lake.docx DOCX document
Attachment 0002 - Approved Herbicide List.xlsx XLSX spreadsheet
Amendment 0001 - 25QA016 SOW Sturgeon Lake.docx DOCX document
W912ES25QA016 0001 Amendment 0001.pdf PDF
Attachment 0004 - WD 2015-4965 rev 25 dtd 12-23-2024.docx DOCX document
Amendment 0001 Sturgeon Lake Reed Canary-Grass Control Map.pdf PDF
Solicitation - W912ES25QA016.pdf PDF

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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:
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:
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