Appendix_K.pdf
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- Park Cleaning Services Wappapello Lake Missouri
- Solicitation number
- W912P9-17-R-0005
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PRE-USE FORM FOR PESTICIDE APPLICATION
Contract/Lease/Easement NO.
Compartment #/Area of Application
Contractor/Lessee/Easement Holder
Address
City
Phone #
Pesticide (Trade Name)
Target Pest
Pesticide EPA Registration #
EPA Classification General Use Restricted Use
Additional Remarks
**NOTE: Photocopies of pesticide license and chemical label must be submitted with pre-use application.
Submitted By: Date:
Signature of applicator
Approved Disapproved
Date:
Eric Lemons Natural Resources Specialist
Reason for disapproval:
Comments:
POST-USE PESTICIDE REPORT
Contract/Lease/Easement NO.
Compartment #/Area of Application
Contractor/Lessee/Easement Holder
Address
City
Phone #
Pesticide (Trade Name)
Target Pest
Application Rate ____ ______
Acres applied to ____________
Pesticide EPA Registration #
EPA Classification General Use Restricted Use
Total Amount Applied
Additional Remarks
Signature of lessee Signature of applicator
Signature of applicator
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