DAWSON COUNTY NOXIOUS WEED CONTROL DISTRICT
COMPLIANCE FORM
DATE OF COMPLAINT: _______________ WEED PLAN NUMBER: ____________
VIOLATOR
NAME: ____________________________ PHONE: _______________________
ADDRESS: ________________________________________________________
Legal description:______ 1/4 ______ 1/4 _______ 1/4, S___T___R___
Latitude: _____________________Longitude: _______________________ (Decimal Degrees) of approximate center of infestation
[ ] Written complaint [ ] Verbal complaint [ ] Weed Board complaint [ ] Other, specify ______________
Contacted violator by [ ] phone [ ] in person Date ________
Absentee landowner; [ ] by letter [ ] by posting
Date site inspected: ___________________
VOLUNTARY COMPLIANCE:
Person is willing to file a weed management plan? YES [ ] NO [ ]
Weed management plan was provided YES [ ] NO [ ] if yes, Date provided______
Weed management plan received? YES [ ] NO [ ] If yes, Date:______
Approved? YES [ ] NO [ ]
Hearing requested? YES [ ] NO [ ] if yes, Date of hearing:_____
NONCOMPLIANCE PROCEDURE:
If the violator has not, or will not, file a weed management plan within ten (10) days of the date of Compliance Request Letter , a certified letter of non-compliance will be sent within thirty (30) days or as District resources allow.
Date noncompliance letter was sent: ______________________________
Management plan given/sent to violator YES [ ] NO [ ] if yes, Date_____
Management plan received by violator YES [ ] NO [ ] if yes, Date_____
Approved? YES [ ] NO [ ]
Hearing requested? YES [ ] NO [ ] If yes, Date of hearing ___________
[ ] No action taken by violator, complaint filed with the Justice of the Peace. Date filed: ________
FORM 941
5 YEAR NOXIOUS WEED MANAGEMENT COMPLIANCE FORM
WEED MANAGEMENT SEASONS: ____________ TO ______________
DATE ENTERED INTO: ______________________________________________
NAME OF APPLICANT: ______________________________________________
ADDRESS: ________________________________________________________
STATE: _______ ZIP: _______ PHONE:(HOME) ________(WORK)________
Legal description:______ 1/4 ______ 1/4 _______ 1/4, S___T___R___
Latitude: _____________________Longitude: _______________________ (Decimal Degrees) of approximate center of infestation
Land use: [ ] Garden [ ] Residential [ ] Commercial [ ] Pasture/noncrop [ ] Agriculture
If Agriculture, please list what type(s): ____________________________________________
Noxious weeds present: _______________________________________________________
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OFFICE USE ONLY
WEED MANAGEMENT PLAN NUMBER: ___________________________________
TYPE OF CONTROL TO BE USE: _________________________________________
ADDITIONALS REQUIRED FORMS
[ ] MANAGEMENT PLAN [ ] REVEGETATION PLAN
[ ] ENVIRONMENTAL ACTION CHECKLIST [ ] MAP
DAWSON COUNTY WEED BOARD: ______ APPROVED
______ APPROVED WITH MODIFICATIONS
______ DISAPPROVED
___________________________ __________
APPLICANT/LANDOWNER DATE
___________________________ __________
DAWSON COUNTY WEED SUPERVISOR DATE
___________________________ ___________
DAWSON COUNTY WEED BOARD CHAIRMAN DATE
Dawson County Weed Department
Equipment Rental Rates
$25/ day slide in pickup sprayer**
$20/ day four wheeler sprayer
$15/ day spray boom
$10/ day backpack sprayer
One day will be 24 hours from time of pickup of equipment. If not returned within 24 hours, an additional day will be charged on bill.
**MUST BE RETURNED WITH FULL TANK OF FUEL. $4.50 GALLON FUEL CHARGE WILL BE ADDED TO BILL IF NOT FULL.
DAWSON COUNTY WEED DEPARTMENT SPRAY RATES:
$75.00/HOUR FOR EACH OPERATOR WITH EQUIPMENT (CHEMICAL NOT INCLUDED)
For more information call Joe or Heath at the Dawson County Weed Department @ 377-6546
EQUIPMENT AVAILABLE TO RENT
SLIDE IN SPRAYER
300 GALLON
150 GALLON
50 GALLON
RECEIEVER HITCH PICKUP BOOM SPRAYER
4 WHEELER SPRAYER
BACKPACK SPRAYER
DAWSON COUNTY WEED DISTRICT EQUIPMENT RENTAL AGREEMENT
The Dawson County Weed District agrees to rent ( Equipment) to (customer.) hereinafter designated to customer agrees to accept the equipment subject to the terms and conditions in this agreement.
TERMS AND CONDITIONS
Equipment: The equipment is and shall remain the property of the Dawson County Weed Department. Customer shall not remove, alter, or efface any indications of Dawson County Weed Department ownership.
Fees: Customer agrees to pay (amount) per day for use of said equipment.
Rental Period: The rental period begins on the date and time the equipment is picked up by the customer. For example, if the equipment was picked up at 3:30 pm on 5 July 2012 it would be due back by 3:30 pm on 6 July 2012. If customer holds the equipment beyond the terms of this agreement or any agreed extension, it will be liable for a full day’s rental fee for each day the equipment is not returned. Equipment can be rented for more than 24 hours. The number of days rented will be agreed upon by the customer and Dawson County Weed Department Representative. Rental fees are based upon a 24 hours period only.
Condition of Equipment: Prior to being released to customer, condition of equipment will be inspected and documented by a Dawson County Weed Department Representative. Upon receiving rental equipment, customer accepts all responsibility for the equipment. Customer agrees not to alter or change any part of the equipment whatsoever.
Use and Storage of Equipment: The location, use and storage of the equipment shall be such as to provide, at all times, reasonable safeguards against damage, loss, or theft. Customer accepts full responsibility for any damage to, or loss or theft of, the equipment, up to and including the full cost of replacing the equipment. Customer agrees to use only the type of fluid or chemical approved by the Dawson County Weed District in its equipment.
Warranty: The Dawson County Weed District warrants that the equipment will be in good and operating condition. In absence of notice to Dawson County Weed Department within 2 hours of picking up equipment, customer acknowledges that the equipment is in good and operating condition. Dawson County Weed District makes no warranties or representations regarding the equipment other than as expressly stated in the agreement. Dawson County Weed District does not warrant the merchantability of the equipment or its fitness for any particular purpose or use, whether or not such purpose or use is disclosed by the customer. Dawson County Weed District shall not be liable for any injuries to persons or property, consequential damages, business interruption or loss of profits when renting out its equipment.
Loss or Damage: Customer shall return the equipment in the same condition as upon receiving it. Customer assumes full responsibility for loss, damage or injuries resulting from the use of the equipment shall be liable to Dawson Count Weed District for loss or damage to the equipment up to the full replacement value.
Repairs, Upgrades, and Service: Customer shall notify Dawson County Weed District of any malfunction of the equipment. Any and all installations, assembly, disassembly, upgrades, servicing and repairs shall be made only by Dawson County Weed Department. Customer shall bear the cost of servicing made necessary by customers fault or negligence.
Governing Law and Venue: This agreement shall be governed by the laws of the State of Montana and any legal actions regarding this agreement shall be brought in the state and federal courts in the State of Montana.
PRE RENTAL EQUIPMENT INSPECTION BY: _________________________
Comments by inspector: ________________________________________________________________
Start Date and time of Equipment Rental: _______________________________________
Return Date and Time of Equipment Rentals: _____________________________________
___________________________ __________
(Customer) Date
___________________________ __________
Dawson County Weed Department Representative Date
POST RENTAL EQUIPMENT INSPECTION BY:________________________________
Comments by inspector: __________________________________________________________________
___________________________ __________
(Customer) Date
___________________________ __________
Dawson County Weed Department Representative Date