The URL can be used to link to this page

Browse Search

Home My WebLink About20240126.tiffRESOLUTION RE: APPROVE 2023 ANNUAL REPORT FOR DISCHARGES FROM APPLICATION OF PESTICIDES AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with the 2023 Annual Report for Discharges from the Application of Pesticides from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Public Works, to the Colorado Department of Public Health and Environment, with further terms and conditions being as stated in said annual report, and WHEREAS, after review, the Board deems it advisable to approve said annual report, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the 2023 Annual Report for Discharges from the Application of Pesticides from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Public Works, to the Colorado Department of Public Health and Environment, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said annual report. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 17th day of January, A.D., 2024. BOARD OF COUNTY COMMISSIONERS ATTEST: ditifoo Weld County Clerk to the Board BY: ,I,J iC IL Deputy Clerk to the Board County Attorney , I ) Date of signature: // 5J Z l WELD COUNTY, CO Kevi erry L c _t�_l Ross, Chair Ol,&a , Pro-Tem r eeman CC (cN/DN/DD/SQ tn3) .2/2 i/24 2024-0126 EG0082 BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW PASS -AROUND TITLE: Pesticide Annual Report for NPDES Compliance DEPARTMENT: Public Works DATE: January 8, 2024 PERSON REQUESTING: Tina Booton Brief description of the problem/issue: As part of the National Pollutant Discharge Elimination System (NPDES) requirements for making chemical (pesticide) applications to areas that may impact waters of the State, an annual report must be filed with the Colorado Department of Public Health and Environment (CDPHF,) by February of the following year. This annual report is required to cover all chemical applications for the 2023 calendar year. This includes bare - ground treatments from January 1, 2023, through December 31, 2023, as well as all roadside treatments and handgun applications made during this same time frame. This permit started in 2013 with threshold requirements set at 20 linear miles or 80 surface acres. Since 2015 CDPHE has required entities to report after the year ended actual quantities of products that were used the previous year. A fee of $281 will be assessed after the submission of this annual report. The bill will arrive in April from CDPHE. This fee was included in the Weed Division budget planning process for 2024. Attached is the completed compliance certificate for 2023 for review and signature. What options exist for the Board? (include consequences, impacts, costs, etc. of options): Option A- Chair sign the annual report. Option B- Authorize another agent to sign the annual report. Recommendation: Option A- Chair sign the annual report. Approve Schedule Recommendation Work Session Other/Comments: Perry L. Buck, Pro -Tern Mike Freeman Scott K. James Kevin Ross, Chair Lori Saine mf. 2024-0126 On2.. MEMORANDUM TO: Clerk to the Board DATE: January 17, 2024 FROM: Tina Booton, Public Work Curtis Hall, Director Public Works SUBJECT: Agenda Item Attached is the Annual Report for herbicide applications made in 2023 under the National Pollutant Discharge Elimination System requirements, which covers waters of the state including Weld County's roadside ditches which can hold storm water. The Chair's signature is required on this document. With the original returned to Public Works, attn: Tina Booton for submission to CDPHE. Please add this item to the agenda for Wednesday, January 17, 2024. COPS ANNUAL REPORT FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES COG860000 'COLORADO Department of Public Health 8 Environment Dedicated to protecting and improving the health and environment of the people of Colorado ANNUAL REPORT FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES C00860000 Digitally signed documents may be emaited to: cdphe.wqrecordscenter@state.co.us NOTE: SUBMISSION OF THIS REPORT CONSTITUTES A RECORD OF COMPLIANCE FOR DISCHARGES MADE TO WATERS OF THE STATE ONLY. EPA ADMINISTERS THE PESTICIDE GENERAL PERMIT FOR FEDERAL FACILITIES. CONTACT EPA FOR FURTHER INFORMATION REGARDING FEDERAL FACILITIES. Please print or type. Original signatures are required. Submission of this completed Annual Report constitutes notice that the Operator identified under item B.2 is authorized to discharge pollutants to surface waters of the state of Colorado. To certify compliance, all information required on this form must be completed. See instructions at the end of this form for completing the certification. Year of report [Ian- Dec 2022 jJan - Dec 2023 Jan - Dec 2024 EJan - Dec 2025 Qother Submit forms to: Colorado Department of Public Health and Environment Water Quality Control Division 4300 Cherry Creek Drive South WQCD-P-B2 Denver, Colorado 80246-1530 ANNUAL REPORT A. Notice of Status 1. Mark whether this is the first time you are certifying compliance under the Pesticide General Permit or if this is a change of information for a discharge already certified under the Pesticide General Permit. If this is a change of information, supply the Operator Name for the discharge. a.❑ First time Annual Report ba Annual Report representing new information (e.g. reporting for a new discharge season) Certification number cocs60t25 c.❑ Annual Report Change of Information: Operator name Please note: When selecting A.1.b above, please fill out Item number 8,1 below (Decision -maker name and mailing address) and modify the pertinent fields of the Annual Report as necessary. Contact Information 1. Legal Contact (Decision Maker) Company Name weld County First Name Kevin Last Name Ross Title Board of County Commissioners Chair Mailing Address ,...758 City, State and Zip Code Greeley, co 60632 Phone 070-336.7204 E-mail Address srosssawaidgovcorn Cell 2. is the Decision Maker for this Annual R for _a Lame Entilyos defined In Appendix A of the Dermit? D YES ❑ NO Note that if you answered "Yes" to question B.2, you are required to develop a Pesticide Discharge Management Plan (PDMP) that reflects all pesticide uses for which you are requesting permit coverage. 1 of 3 CDP5 ANNUAL REPORT FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES COG860000 3. Operator (if different from Decision Maker) Company game Weld County Mailing Address PO Boo 758 City, State and Zip Code Greeley, CO 80632 First Name Tina Last Name Booton Title Weec Division Supervisor phone 970-400-3770 Cell 970-381-4052 E mail Addresstbooton@weldgov.com 4. Operator Type (check one): ❑ State Govt Cl Local Govt 0 Mosquito Control District(or similar) ❑ Irrigation Control District (or similar) 0 Need Control District (or similar) 0 Other: 5. Facility Contact p same as applicant Company Name Weld County Mailing Address PO Box 758 City, State and Zip Code Greeley, CO 80632 First Name Tina Title Weed Division Supervisor Last Name Booton Phone 970400-3770 Cell 970-381-4052 E-mail Address tbooton@weldgov.com Additional Operator Information if applicable: 6. Authorized Reporting Agent (DMR Cognizant Official) 0 same as applicant (i.e. person or position authorized to sign and certify reports required by the permit: DMR's, Annual. Reports, Compliance Schedule submittals, etc., as requested by the division.) Company Name Mailing Address City, State and Zip Code First Name Last Name Title Phone Cell E-mail Address 7. Billing Address and Contact 0 same as applicant Company Name Weld county Mailing Addaess PO Box 758 City, State and Zip Code Greeley, CO 80632 First Name Tina Last Name Booton Title Weed Division Supervisor Phone 970-L0-3770 E-mail Address tbooton@weldgov.com Cell 970-381-4052 2 of 3 CDPS ANNUAL REPORT FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES COG860000 9. Water Quality Impaired Waters Operators are not eligible for coverage under this permit for any discharges from a pesticide application to surface waters of the state if the waters are identified as impaired by a substance which is either an active ingredient of the pesticide designated for use or is a degradate of such an active ingredient. (Check one) ❑ Waters are NOT impaired by any substance which is either an active ingredient of a pesticide to be discharged or a degredate of such an active ingredient. Waters are on a current state list as being impaired by a substance which is either an active ingredient of a pesticide to be discharged or a degradate of such an active ingredient; however, evidence is attached documenting that the waters are no longer impaired. 10. Pest Evaluation a. Identify the target pest(s) and explain why pest control is needed" See attached sheet `Please attach additional pages as necessary b. Describe pest management measure(s) implemented before first pesticide application For example, identify if you have performed physical control techniques such as pulling weeds, removing breeding habitat, or trapping animals.* See attached sheet Pleas ttach additional pages as necessary 11. Pesticide Application Start Date January 1, 2023 End Date December 15, 2023 12. Name of each pesticide product used, EPA Registration number and Quantity of pesticide applied (as packaged or as formulated). The total quantity of pesticide applied and the pesticide application end date must be completed as soon as possible but no later than 14 days after completion of pesticide application for this project." Product Name EPA Registration Number Quantity (lbs OR gallons) Application method e.g., fixed wing aircraft, backpack sprayer 2,4-D Milestone 11773-2 62719-519 ib lb Gal 164.91 is% Handgun; 65% chemical injection truck Gall 0.61 25% Handgun; 75% chemical injection truck Panoramic 2SL 66222-141-81927 lb Gal 9.76 25% Handgun; 75% chemical injection truck Tordon 22K 62719-6 lb Gal 75.1 100% chemical injection truck Venue 71711-25 lb GatO,22 10% Handgun; 90% chemical injection truck *Please attach additional pages as necessary 13. Visual monitoring was conducted during pesticide application and/or post application El YES ❑ NO If no describe why not: 14. Were any adverse effects identified dun visual monitoring? 0 YES 0 NO If yes, describe: Pest Management Area Information Pages 4 and 4A Attached Sheet: Weld County Compliance Certificate Question 10 A: Target Pest(s): Purple Loosestrife, Russian olive, Tamarisk, Canada Thistle, Field Bindweed, Diffuse Knapweed, Russian knapweed, Hoary Cress, Perennial Pepperweed, Leafy Spurge, Musk thistle, Scotch thistle, Bull thistle, Absinth Wormwood, Dalmatian Toadflax, Spotted Knapweed, Russian Thistle, Kochia, Sunflowers, Curly Dock and Cockleburs. The first fou-teen plant species are deemed noxious weeds by the Colorado Department of Agriculture. They need to be controlled and not allowed to expand their population borders. Some of the species are also set for mandatory eradication based on the location of the weeds along routes of spread such as roadsides, irigation ditches and rivers. The last five species are nuisance weeds that limit visibility and movement along the road system in Weld County. Question 108: Due to the size of Weld County and the number of miles that must be maintained throughout the County, no other pest management measures are implemented before the roadside spraying operation begins. While the roadside spraying operation is being conducted decisions are made in the field as to the need to spray areas as the trucks are passing by. 12. Name ce each pesticide product used. Product Name EPA Registration No. Quantity Application Method Pendulum Aquacap 241-416 44.1 gal 100% tank mix truck Telar XP 352-404 1.6 lbs Handgun 100% Imitator (glyphosate) _ 62719-324 15.25 gal Handgun 100% Polaris 228-534 8.98 gal Handgun 100% Perspective 342-846 24.68 lbs Handgun 50%; Tank Mix Truck 50% Vista XRT 62719-586 0.09 gal Handgun 100% Frequency 7969-281 4.34 gal Handgun 100% Rejuvra 432-1609 0.43 gal Handgun 50%; 50% tank mix boom spray truck Piper EZ 59639-237 8.68 gal Handgun 50%; Tank Mix Truck 50% Derigo 432-1533 _ 3.3 lbs Tank mix truck 100% Garlon 3A 62719-37 0.25 gal Handgun 100% • • a 4. • • • • • • • • a • a • • • • • • • • �•.{ • • • • • • 5555•• • • • • • • • at •s• k • • • • • • •_ • . •ire ••aea ata•asp • • • • • S • -41.11 • a •••s•at ••• a_% ss • a • 9 • •ac& • • • • • • r e.s ••• wag eel •a• • • • �• a 1 • • • I • • • • • •• • sr • V .•••••ace •• _4..a • • • • • • • • •• • • f at • • • • • • 6 sad • ag •y• a.M•L•M •r•.•• • a • • J.. 4 new a • • • • • • • • •S•• •aa4• • • . • • • •••1• • •• • • • • • • • • a • • • a u 404 • w . • • • • f • •cassail • • • .. 5 • • • • • •deer r • • • • r5..{ • a0 • • • •• . • • ••• •11. a -• soolloasailL•• -sA • • stalet • • •••.4 • • i • �.•.•+. • • • • • • • A tars* • • • • • • i • • • ♦ ! • • • • ' a • • • a a•a a. •• Sam s .. m • • ta • • • • •••ard% • •• IS • • • • . am • • • • ••ea•a as L,•••5 • • • • • I • • • • • • a • • • • as o• se`er . �•� • leetat • • • • 4••.•a•. • • a . , • • Na Las f • • • M' to • • • • M • P•I • 4 44.•7r Wier- • • • es ems pass. �i 4.t • • . • • • • • • • • Ate • . • • • • • • • • • • • • .5•• f • • •• • • • ••.� ti .; 9 • Sad. • •• • e • • • • • • • • �••.• •.• tsars •r•• • • g•• «. . ZIP —• ---• - • • • a at •s• • • • •.•-arae•aa. • • • • • t �Y� • • `• •• 5 ,•• • • • • • • • • N • a s• I • 1 • • • • • • • : • e • • a • .5..•r•t • • • • • • • • • • • e• • • • • • • •'S • • • ;• 1 • • a • • • • • • • • ?.}aa•....••�• • • • • • • • • •• • . • • • Cs:• • ••••.•• ••a•.•Iw•:••�••`••a4•aea•••eSa1• uk y • • • • • • • • • • • • - ,..y s •a5 • •ails • • • 4 5 • . • t.• • ••y = • • •a-4•.aa.•� it f • • • • • a •••• • a w ate Ansel • •a.�.•••• Oa •r••..•• •i sae -• • • •• • •. ••• a 5a • • • • • • ........... • • • • • •• • • • • • a. • • • • • • 1 • r• • • MISS •aa•• • • •rr.ar1 w ♦a••• • I 4••• eit. ii • f • • • •• • • • • • ab • �� •• �N••1•t•N •• • • a!a►•►•• • ��a•ai •I • MSS • • • • ' • • •:•.. :Ls �ss..� • •' • . • . • • • . Cs�,ss•a1i` • • • • i • •• • • • • • • • • • • • • • • *.t I •. • • • • • • 0 ••••sra• • • • • I • • • • f • • . • • • • • • • • • • • 1 • • • • • • • • • • • • • •• • • Lae • • • • • • •• a •s• • • • • be • ••ta • • • • a • • • • • • • • •r • • • • • • • • • • • • • • • • • • . • • • • �� • • • • • 9 �S 46 • a • • • ••••••••••••S+144•1140•0 411.•;•• •aa • • • • • • • • • a a • a • a • e • r- • • t • f • • • 50.sa`.P • • • • t J • esea • sq 10 • 5555•. • • • • • • basil • • • • • • • • • • • fee OS DS& • • • • • • • • its • • • • •40 so a sae • • • • • • • • • • • Co • • • • • Ilea • • • • • • a • • • • • a is • • • Weld County Legend * Grader Stations Gravel Pits Activity • Active 0 Inactive Jan 2011 County Maintenance ADMINCLASS 1 Arterial Service 2 Local Service 3 Hatf and Half CDPS ANNUAL REPORT FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES COG860000 COLORADO Department of Public Health & Environment CDPHE ,v Dedicated to protecting and improving the health and environment of the people of Colorado ANNUAL REPORT FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES COG860000 Digitally signed documents may be emailed to: cdphe.wqrecordscenter@state.co.us NOTE: SUBMISSION OF THIS REPORT CONSTITUTES A RECORD OF COMPLIANCE FOR DISCHARGES MADE TO WATERS OF THE STATE ONLY. EPA ADMINISTERS THE PESTICIDE GENERAL PERMIT FOR FEDERAL FACILITIES. CONTACT EPA FOR FURTHER INFORMATION REGARDING FEDERAL FACILITIES. Please print or type. Original signatures are required. Submission of this completed Annual Report constitutes notice that the Operator identified under item B.2 is authorized to discharge pollutants to surface waters of the state of Colorado. To certify compliance, all information required on this form must be completed. See instructions at the end of this form forcompletingthe certification. 1 Year of report _IJan- Dec 2022 a Jan - Dec 2023 ❑Jan - Dec 2024 ❑Jan - Dec 2025 ❑ other Submit forms to: Colorado Department of Public Health and Environment Water Quality Control Division 4300 Cherry Creek Drive South WQCD-P-B2 Denver, Colorado 80246-1530 ANNUAL REPORT A. Notice of Status 1. Mark whether this is the first time you are certifying compliance under the Pesticide General Permit or if this is a change of information for a discharge already certified under the Pesticide General Permit. If this is a change of information, supply the Operator Name for the discharge. a.❑ First time Annual Report b.❑■ Annual Report representing new information (e.g. reporting for a new discharge season) Certification number cous0002s c.❑ Annual Report Change of Information: Operator name Please note: When selecting A.1.b above, please fill out Item number B.1 below (Decision -maker name and mailing address) and modify the pertinent fields of the Annual Report as necessary. B. Contact Information 1. Legal Contact (Decision Maker) Company Name Weld County First Name Kevin Title Board of County Commissioners Chair Last Name Ross Mailing Address PO Box 758 City, State and Zip Code Greeley, CO 80632 Phone 970-336-7204 Cell E-mail Address kross@weldgov.com 2. Is the Decision Maker for this Annual Report a Large Entity as defined in Appendix A of the permit? El YES ❑ NO Note that if you answered "Yes" to question B.2, you are required to develop a Pesticide Discharge Management Plan (PDMP) that reflects all pesticide uses for which you are requesting permit coverage. 1 of 3 CDPS ANNUAL REPORT FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES COG860000 3. Operator if different from Decision Maker) Company Name Weld County Mailing Address PO Box 758 City, State and Zip Code Greeley, CO 80632 First Name Ti.a Last Name Booton Title Weed D vision Supervisor Phone 97040O-3770 Cell 970-381-4052 E-mail Address tbooton@weldgov.com 4. Operator Tape (check one): 0 State Govt 0 Local Govt ❑ Mo;quito Control District(or similar) ❑ Irrigation Control District (or similar) 0 Weed Control District (or similar) ❑ Otl-er: 5. Facility Contact ❑ same as applicant Company Name Weld County Mailing Addre;s PO Box 758 City, State and Zip Code Greeley, CO 80632 First Name Tina Last Name Booby Title Weed Division Supervisor Phone 970-403-3770 Cell 970-381-4052 E mail Address tbooton@weldgov.com Additional Operabr Information if applicable: 6. Authorized 1porting Agent (DMR Cognizant Official) O same as applicant (i.e. person or position authorized to sign and certify reports required by the permit: DMR's, Annual Reports, Compliance Schedule submittals, etc., as requested by the division.) Company Name Mailing Addren City, State an I Zip Code First Name Last Name Title Phone Cell E-mail Addren 7. Billing Addres: and Contact ❑ same as applicant Company Name Weld county Mailing Addrem PO Box 758 City, State and Zip Code Greeley, CO 80632 First Name TIr. Last Name Booton Title Weed Diiision Supervisor Phone 970-401-3770 Cell 970-381-4052 E-mail Addrem tbooton@weldgov.com 2 of 3 CDPS ANNUAL REPORT FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES COG860000 C. ANNUAL REPORT REQUIRED SIGNATURE Signature of Operator: The Annual Report must be signed to be considecedcomplete. In all cases, it shall be signed as follows: a) In the case of corporations, by a principal executive officer of at least the level of vice-president or his or her duly authorized representative, if such representative is responsible for the overall operation of the facility from which the discharge described in this form originates. b) In the case of a partnership, by a general partner. c) In the case of a sole proprietorship, by the proprietor. d) In the case of a municipal, state, or other public facility, by either a principal executive officer, ranking elected official, or other dulyauthorized employee if such representative is responsible for the overall operation of the facility from which the discharge described in theform originates. "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. On the basis of my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Certifier Name (printed) Kevin D. Ross, Chair Certifier Title Board of County Commissioners Certifier Email kross@weldgov.com Certifier Signature/Responsible Official: --.----------(D- .3 Date Signed JAN 1 7 2024 3 of 3 aDo24-0424 CDPS ANNUAL REPORT FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES COG860000 Complete and Attach Pages 4 and 4A for Each Pest Management Area D. Pest Management Areas Complete this section for each Pest Management Area for which Pesticide General Permit coverage is desired. Pest management area, as defined in Appendix A of the permit, can be a large area (e.g., an entire town) or a very specific well-defined management area (e.g., a lake). Thus, a pest management area can have one or more treatment areas 1. Pest Management Area Information: Area # 1 of ##1 (e.g. 1 of 5), please attack- additional pages as needed if you are certifying multiple areas. 2. Pest Management Area Name: Unincorporated Weld County Street Address, if applicable (or cross streets) City CO, Zip Code County 3. Provide a map of the location of the Pest Management Area showing the treatment area within the Pest Management Area (Attach Map) 4. Size of Treatment Area 2,509,798 Acres or 31,901,760 Linear Feet 5. Contact Infornation for pesticide applicator p Same as operator listed in item 1 page 1 of application Company Name Weld County Mailing Address 7O Box 758 City, State and Zip Code Greeley, co 80632 First Name Tna Last Name Booton Title Weed Division Supervisor Phone 970-400-370 E-mail Addres tbooton@weidgov.com Cell 970-381-4052 6. Pesticide Use Patterns to be included in this Pest Management Area (Check all that apply) ❑ Mosquito and other flying insect pest control ❑ Forest canopy pest control ❑ Animal pest control p Weed and algae pest contol 7. Receiving Waters as applies to Pest Management Area -Item 1 above (Check One) Forall surface waters of the state ❑ Forthe following surface waters of the state 0 Forall surface waters of the state except for: 8. Outstanding Waters Is coverage requested for discharges to outstanding water(s) of the state? YES ❑ NO ❑ If YES Name of Outstanding Water(s) Provide rationale for determination that pesticide discharges are necessary to protect water quality, the environment, and/or public health and that any such discharge will not degrade water quality or will degrade water quality only on a short term or temporary basis - attach additional pages as needed: CDPS ANNUAL REPORT FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES COG860000 9. Water Quality Impaired Waters Operators are not eligible for coverage under this permit for any discharges from a pesticide application to surface waters of the state if the waters are identified as impaired by a substance which is either an active ingredient of the pesticide designated for use or is a degradate of such an active ingredient. (Check one) 0 Waters are NOT impaired by any substance which is either an active ingredient of a pesticide to be discharged or a depredate of such an active ingredient. ❑ Waters are on a current state list as being impaired by a substance which is either an active ingredient of a pesticide to be discharged or a degradate of such an active ingredient; however, evidence is attached documenting that the waters are no longer impaired. 10. Pest Evaluation a. Identify the target pest(s) and explain why pest control is needed* See attached sheet *Please attach additional pages as necessary b. Describe pest management measure(s) implemented before first pesticide application For example, identify if you have performed physical control techniques such as pulling weeds, removing breeding habitat, or trapping animals.* See attached sheet *Please attach additional pages as necessary 11. Pesticide Application Start Date January 1, 2023 End Date December 15, 2023 12. Name of each pesticide product used, EPA Registration number and Quantity of pesticide applied (as packaged or as formulated). The total quantity of pesticide applied and the pesticide application end date must be completed as soon as possible but no later than 14 days after completion of pesticide application for this project.* Product Name EPA Registration Number Quantity (lbs OR gallons) Application method e.g., fixed wing aircraft, backpack sprayer 2,4-D 11773-2 lb Gal 164.91 15% Handgun; 85% chemical injection truck Milestone 62719-519 lb Gal10.61 25% Handgun; 75% chemical injection truck Panoramic 2SL 66222-141-81927 lb Gal 9.76 25% Handgun; 75% chemical injection truck Tordon 22K 62719-6 lb Gal 75.1 100% chemical injection truck Venue 71711-25 lb Gal0 22 10% Handgun; 90% chemical injection truck *Please attach additional pages as necessary 13. Visual monitoring was conducted during pesticide application and/or post application ❑ YES ❑ NO If no describe why not: 14. Were any adverse effects identified during visual monitoring? ❑ YES to NO If yes, describe: Pest Management Area Information Pages 4 and 4A Instructions Part 1 Completing the Annua. Report Form: To complete this form, type or print in the appropriate areas. Please make sure you complete all questions. Make sure you make a photocopy for your records before you send the completed original form to the address above. A. Notice of Status 1. Status Indicate if this is the first time you are requesting coverage under the permit for these discharges. Refer to Table 2 for report submittal deadlines and discharge authorization dates. If this is a change of information for a discharge where the Anrual Report has already been submitted, supply the name of the Operator under which the Annual Report was submittec For additional details regarding a change of information, see Table 3. Also fill out Item 1 of this form (Operator Name and Mailing Address) and the associated fields of information that need to be modified on the Annual Report. B. Operator Information 1. Is the Operator a large entity as defined in Appendix A? a. YES - (Mote that a "Yes" here will require preparation of a Pesticide Discharge Management Plan reflecting uses for wnich you seek coverage). b. NO - (dote that a "No" answer does not necessarily exempt you from submitting a Annual Report as you may need to submit if thresholds are exceeded. Please see Table 7-2. If you do not meet the threshold for submittal of an Annual Report, you are requested to complete and retain this application for at least 3 years from the date :hat coverage is granted under the permit or until the permit expires or is terminated. 2. Provide the legal name of the person, firm, public organization or any other public entity that is the Decision -maker for the pesticides applications described in this notice. A Decision -maker is an Operator who has control over the decision to perform Imsticide applications, including the ability to modify those decisions, that result in a discharge to Waters of the State. 3. Indicate toe type of Operator: federal government, state government, local government, mosquito control district (or simila-), irrigation control district (or similar), weed control district (or similar), or other. If other, provide brief description of type of Operator in the space provided Additional Operator information, if applicable: 4. Provide the Facility mailing address, telephone number(s) and email address. 5. Provide the Authorized Reporting Agent (DMR Cognizant Official) contact information 6. Provide the Billing contact and address. C. Certification Enter the certifier's printed name and title. Sign and date the form. For more information about the certification statement aid signature, see Appendix B of the permit. (CAUTION: An unsigned or undated form will not be accepted.) Signature of Operator: The Annual Report must be signed by the Decision -maker to be considered complete. In all cases, it shall be signed as follows: a) In the cae of corporations, by a principal executive officer of at least the level of vice-president or his or her duly authorized representative, if such representative is responsible for the overall operation of the facility from which the discharge described in the application originates. b) In the cae of a partnership, by a general partner. c) In the case of a sole proprietorship, by the proprietor. d) In the cae of a municipal, state, or other public facility, by either a principal executive officer, ranking elected official, or other duly authorized employee if such representative is responsible for the overall operation of the facility from which the discharge described in the form originates. D. Pest Management Area: Information for each Pest Management Area for which coverage under the State 's Pesticide General Perenit is desired. 1) Indicate whether you are submitting an Annual Report for multiple pest management areas. A pest management area is the area of land, including any water, for which you have responsibility and are authorized to conduct pest management activities as covered by this permit (e.g., if you are a mosquito control district, your pest management area is the total area of the district). You must complete the Pest Management Area information page for each past management area. If you are submitting an Annual Report for only one area, enter "1" of "1." If you are submiting Annual Reports for multiple pest management areas, enter the number "X" of "X(" (the specific number of the ante of the total number of pest management areas for which you are requesting coverage). 2) Enter the name of the pest management area. 3) Attach a map of the pest management area or describe the location of the pest management area in the space provided. 4) Enter the size of the treatment area in acres or linear feet 5) Enter the mailing address of the contact person for the pest management area. If this address is the same as the Decision -maker's mailing address, indicate that by checking the box. If it in a different address, enter the mailing address, telephone number, fax number (optional), contact name, and e-mail address. 6) Indicate the pesticide use patterns for the pest management area for which the Annual Report is required. For additional information regarding pesticide use patterns, see Part 1.1.1 of the permit. Check all the use patterns that apply to the pest management area. INSTRUCTIONS Part 1 7) Receiving Waters Indicate if permit coverage is being requested for all Waters of the State within the pest management area or if permit coverage is being requested to specific Waters of the State within the pest management area. If specific waters are being requested, write the names of the waterbodies. If permit coverage is being requested for all waters of the State within the pest management area except for specific waterbodies, name those specific waterbodies in the space provided. EPA's Water Locator Tool can help you identify the closest receiving water to your facility http: / /cfpub. epa. Rov/ npdes/ stormwater/tmdltool. cfm. 8) Outstanding Waters Indicate if permit coverage is being requested to discharge to an Outstanding Water of the State. If yes, write the name(s) of the Outstanding water(s) in the space provided. Describe and demonstrate why it is necessary to apply the pesticide, (e.g. to protect the water quality, environment, and/or public health) and detail why said discharge will not degrade water quality or will degrade water quality only on a short-term or temporary basis. 9) Water Quality Impaired Waters Verify that waters within the pest management area are either not impaired by substances which are either active ingredients in the pesticide planned for use, or degradates of such active ingredients; OR that evidence shows that the target waters in question are no longer impaired. See Part 1.1.2.1 of the permit for more information on discharges to Water Quality Impaired Waters. 10) Pest Evaluation a. Identify the target pest(s) and provide a brief description of why pest control is needed. a. Provide a brief description of any Pest Management Measure(s) implemented before pesticide application. For example, identify if you have performed physical control techniques such as pulling weeds, removing breeding habitat, or trapping animals. 11) Pesticide Application Start and End Dates 12) Name of each pesticide product used, EPA Registration number and Quantity of pesticide applied (as packaged or as formulated) 1. Provide the company name and contact information of the pesticide applicator. 2. Enter the date that the pesticide application began and ended. 3. Enter the trade name or active ingredient of each pesticide product used including the EPA Registration Number, the quantity of pesticide applied, and the method used to apply the pesticide (e.g., fixed wing aircraft, backpack sprayer). 13) Indicate if visual monitoring was conducted during the pesticide application and/or post -application. If visual monitoring was not performed, provide a brief description of why visual monitoring was not conducted. 14) Indicate if there were any adverse effects identified during visual monitoring. Provide a brief description of effects seen. INSTRUCTIONS Part 2 Who Must File a ANNUAL I€PORT with the Division? Any Operator meetinc the eligibility requirements identified in Part 1.1 of the permit and Table 1 below must submit a complete an Annual Report. As required in the permit, only certain Operators that are also Decision -makers must submit Annual Reports. Table 1. Decision -Masers Required to Submit Annual Reports Permit Part/ Pesticide Use Which Decision -Makers Must Submit Annual Reports? For Which Pesticide Application Activities? All four use patterns identified Any Decision -maker with an eligible discharge to an Outstanding Water consistent with Part 1.1.2.2 Activities resulting in a discharge to an Outstanding Water 1.1.1(a) - Mosquito anc Other Flying Insect Pest Cont©l Any Agency for which pest management for land resource stewardship is an integral part of the organization's operations. All activities resulting in a discharge for which the State agency is responsible for pest control Mosquito control districts, or similar pest control districts All activities resulting in a discharge for which the Decision -maker is responsible for pest control Local governments or other entities that exceed the annual treatment area threshold identified here Adulticide treatment if more than 6,400 acres during a calendar year 1.1.1(b) - Weed and Algae Pest Control Any Agency for which pest management for land resource stewardship is an integral part of the organization's operations. All activities resulting in a discharge for which the Federal or State agency is responsible for pest control Irrigation and weed control districts, or similar pest control districts All activities resulting in a discharge for which the Decision -maker is responsible for pest control Local governments or other entities that exceed the annual treatment area threshold identified here Treatment during a calendar year if more than either: 20 linear miles OR 80 acres of water (i.e., surface area) 1.1.1(c) - Animal Pest Control Any Agency for which pest management for land resource stewardship is an integral part of the organization's operations. All activities resulting in a discharge for which the Federal or State agency is responsible for pest control Local governments or other entities that exceed the annual treatment area threshold identified here Treatment during a calendar year if more than either: 20 linear miles OR 80 acres of water (i.e., surface area) 1.1.1.(d) - Forest Canooy Pest Control Any Agency for which pest management for land resource stewardship is an integral part of the organization's operations. All activities resulting in a discharge for which the Federal or State agency is responsible for pest control Local governments or other entities that exceed the annual treatment area threshold identified here Treatment if more than 6,400 acres during a calendar year If you have questions tout whether you need to file a Annual Report or about completing this form, Contact the Division at 303-692-3517. One Annual Report can be submitted for multiple pest management areas for which you are seeking permit coverage. When to File the Anneal Report Form: Do not file your Annual Report until you have obtained and thoroughly read a copy of the permit. A copy of the permit is on the Division's website www;coloradowaterpermits.com.The permit describes procedures to ensure your eligibility, prepare your Pesticide Discharge Management °lan (PDMP), and complete the Annual Report form questions —all of which must be done before you sign the certification statement on page 2 attesting to the accuracy and completeness of your Annual Report. You will also need a copy of the permit once you have obtained coverage so that you can comply with the implementation requirements of the permit. Note: The PDMP is not required for any application made in response to a Declared Pest Emergency Situation, as defined in Appendix A of the permit. Annul Reports are due to the Division on the first of February each calendar year, and cover discharges made over the course of the previaus calendar year. All eligible discharges are authorized for permit coverage. For any discharges after January 12, 2012, Decision -makers meeting the eligibility Equirements identified in the Part 1.1 of the permit and Table 1 must submit a complete and accurate Annual Report accordiW to Tables 2, and 3 and consistent with the requirements of the Part 1.2 of the permit. INSTRUCTIONS Part 2 Table 2. Annual Report Submittal Deadlines and Discharge Authorization Dates for Discharges from the Application of Pesticides Operator Type Annual Report Submission Deadline Discharges Authorization Dater Any Decision -maker with a response to a Declared Pest Emergency which triggers a Annual Report requirement At least 30 days after beginning the discharges Immediately upon beginning to discharge for activities conducted in response to a Declared Pest Emergency Situation. Any Decision -maker that exceeds any annual treatment threshold February 1 of every calendar year, covering applications made in the previous calendar year. Immediately Any Decision -maker otherwise required to submit a Annual Report as identified in Table 1. February 1 of every calendar year, covering applications made in the previous calendar year. Immediately On the basis of a review of an Annual Report or other information, the State may delay authorization to discharge beyond any timeframe identified in Table 2, determine that additional technology -based and/or water quality -based effluent limitations or other conditions are necessary, or deny coverage under this permit and require submission of an application for an individual CDPS permit, as detailed in Part 1.3 of the permit. TO CHANGE INFORMATION: Dischargers are required to provide to the division, information as it relates to changes in pest management areas and in contact information. To change contact information: o Use the Change of Contact Form on the division website: coloradowaterpermits.com. To add new pest management areas o Submit additional pages 4 and 4A of this document. Revised Annual Report is REQUIRED when: 1. New pest management area is added 2. New contact information is added 3. Discharges to Outstanding Waters not identified in any previous annual report are added 4. Declared Pest Emergency Situations require revised Annual Reports no later than 30 days after the beginning of the discharge to control the emergency situation. Reports should detail the emergency situation and results of efforts to control the target pest. To File the Annual Report Form: Colorado Department of Public Health and Environment Water Quality Control Division 4300 Cherry Creek Drive South WQCD-P-62 Denver, Colorado 80246-1530 • • v •wac-• • • at • • r ,•s•• • ....ray nt Y •_ a +iii.e a • • • • v4 • • • • • q • • w = � a. • • • • • .• oaths qp w Sea. a-cia • s = 4al la ea • • c. c.s. s: s. .• • an • ,•rsa•. • aa! • • a 44 a S a 7 a J La. 0 $32 •al. •;• a a 9 • • a • •teem • • • • • ■paaa a a V • • a _ ,••east ft • • • • feats ••••••••••••••ii eta erste. e• a • • • a • ••••••• al 011 ally 23. Dv is • i •E. • • f • • f a•a.C•i o a. a.rG a.aac ase • a �+� • V a • • 1? • 4 IF • • •f •. Y a• • • it is. • • • • • I a • ■ a u a 1 r T . r • r • • • i sae aa•a• isa•.•••••• aaala• • • • •• •• • fa a a 4 •a a aSa,r a a.7 ad Y • a • • • • • c•• • a • 1.111-14 • • • a 40a•JaaaSi.•4a•4 4 • • ,• •a a • 0 a • aft& �a j • • y aspate • • • • e• • I • • • '3 a ••aoa aoi.ar•-a-v ■ • a 4 a a • a0 • is • • a Mas•al•ss• • . at • Jaa.! • • a3 . * .O i1•+ • « -� a a r a: a• Tar '7� "at a • • • • • aSS. • • • • •i.al • • • U. M r 4. •• •♦a• b • • a oath acab •• • 4 • • • • air a.la a • 0. -••• 'FIEF rc a 62 • 4.e. S. ;s s • • .. • a ra-r� r ! •s•:a• •• '+ �• • I a r • • •s e :- • $ a • .fir • u • i • • • ■ • / . .• • • a. .i•..a.7a! • • • .a • • V • • u • V • V 4 • c • q 2 • 4 9 • 9 • •c * • • a ;ea r-•• •V isa eo N • ' S M • M 4 • • 0 •a.a .: 'Qt • 4011-49-0411, •• • • • • • • a • • • ••I • p ■ . uar.ul • a. *Dirt i■ • • O r o G ats.ma• • • �jaaaataaaara• ; a oaf 0 • a1 a. `„s.�at si•jasaaa�a�+• a.a • • saa•P i a1 •.ice 9 o•Na as. • • • • • • r•a,a4 • • e�saa•a-.aaa4 a • f fpe q 9 . a• •• , a t c d- rs,a.a. •1+I`+:• a a T a 0 T1 0 • q �a • • ••i sS 0 • • 9 • •le� 0 • • • Si .'••Oo • C� Q �• ` a•aais� .{ , •J•.• 'a r: • • �.o o•� • 0 • Ste aa .•a• • • • Saw e . ,ar9 4 • r • • • • *ot, • �• a• • • & • a • & sa aaatr • • • • sanest a • • • • • • • -a • • • I w • • • •a w f w • • I •dbsaa4•11aSaran spaIr•a I. am eft `A • tvite sa a u t %. sr a.cmaa • • • • a i a a•• • -es•• • •c a•• atoa.al. a a ri . a • • • • • !•:'+r' a • cc • a a a •ass•■ ,a' • a •• sie ••• • •, ` a • • • • • • • • i • • I. se • • a • •s r a • • a • r • a • Soave p dals • • ♦ ♦ s • • a • • lapse.. stases * • pai.p• raaaag s• iota • • • • • • •r. s =' a ' a nap s••• • • 7•• • • •or,•-i.et•�ai • r• n i a a f a • • Is I. a • • • • • • • I•• • •+ S •n•s et• •a a s A 30ilea.e elf= ca-aaa.s e.c •1aSas ' 9 • • • in Si a or .. •• • r• • • • n n • • t • • • • I I ?s • • a • • •• • Aasaaaaaaaa .al Ora aasa.%.• ab* • ? • • ~ a • • • • go • • • t.a se a aaM • • • ♦•,, •► S a •• • a ' a a • • s 0 1 • q +a 9 • �• o . • • • • ft • • •-• • • a • a Al • s • • • aI • 41, a • • s • i • a r a to a a as Ca •• • • • ' • • • . • • • .a bat r • a • • • o • Y • • • • • •• a a o a Cs a a • a la• G s as a • A.• • • tai,. • • • a • p•."' • • • • • • ,a.►a at.. a • • • 0 • • �•airsa•`d • • • a a • J a i • Tea" • • • • p.a.a sa ea-as•4+a aSa•a, ,a• aa%a 0 • 1 • • • • • • • • • la aa• • • a • 9 • VILO ia e • ta1►.saes•i•.*an Off • • • • s?ar•.••z s•s► •saista • • • •• • •• • • • • .s e- • 9 1 • p 4. • - ci o G• • •.•• a case • • • • a • as • • e *se • • 0 410 S •'• IS • • • • • • •••••♦ its" • s.aP a a s ••••e -a 0 see • • a ••r•el • 4'"• • • i • • • • • laes. • • • t 0.6.4 • • 0 C • • • • • • i rare OPa • • t aaca • • • • • • • • as asses ea.. so a' • • • .. aS • • • • a• M • • • ♦ ♦ ••ss•s•••s•ea♦ • e • M a r • •.• M NI •• M• a> r v • • f a Salo ,• a • • a•aaas.J•t 0 •s T• r • • • s I.seas sea ate 'SS }.A.6 • a • SIM a. as ass a• a• •r a • S a • a • • • • • Weld County Legend * Grader Stations Gravel Pits Activity • Active e Inactive Jan 2011 County Maintenance ADMINCLASS 1 Arterial Service 2 Local Service 3 Half and Half Attached Sheet: Weld County Compliance Certificate Question 10 A: Target Pest(s): Purple Loosestrife, Russian olive, Tamarisk, Canada Thistle, Field Bindweed, Diffuse Knapweed, Russian knapweed, Hoary Cress, Perennial Pepperweed, Leafy Spurge, Musk thistle, Scotch thistle, Bull thistle, Absinth Wormwood, Dalmatian Toadflax, Spotted Knapweed, Russian Thistle, Kochia, Sunflowers, Curly Dock and Cockleburs. The first fourteen plant species are deemed noxious weeds by the Colorado Department of Agriculture. They need to be controlled and not allowed to expand their population borders. Some of the species are also set for mandatory eradication based on the location of the weeds along routes of spread such as roadsides, irrigation ditches and rivers. The last five species are nuisance weeds that limit visibility and movement along the road system in Weld County. Question 10 B: Due to the size of Weld County and the number of miles that must be maintained throughout the County, no other pest management measures are implemented before the roadside spraying operation begins. While the roadside spraying operation is being conducted decisions are made in the field as to the need to spray areas as the trucks are passing by. 12. Name of each pesticide product used. Product Name EPA Registration No. Quantity Application Method Pendulum Aquacap 241-416 44.1 gal 100% tank mix truck Telar XP 352-404 1.6 lbs Handgun 100% Imitator (glyphosate) 62719-324 15.25 gal Handgun 100% Polaris 228-534 8.98 gal Handgun 100% Perspective 342-846 24.68 lbs Handgun 50%; Tank Mix Truck 50% Vista XRT 62719-586 0.09 gal Handgun 100% Frequency 7969-281 4.34 gal Handgun 100% Rejuvra 432-1609 0.43 gal Handgun 50%; 50% tank mix boom spray truck Piper EZ 59639-237 8.68 gal Handgun 50%; Tank Mix Truck 50% Derigo 432-1533 3.3 lbs Tank mix truck 100% Garlon 3A 62719-37 0.25 gal Handgun 100% Hello