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UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE
AREA
ZONE NUMBER
ASIAN LONGHORNED BEETLE UNIFIED SURVEY
LEVEL (check one)
1
STREET
SURVEY DATA ENTERED
INITIAL
DATE
2
TOWN
ZIP CODE
TYPE OF SURVEY (check one)
First attempt
Call back
SURVEYOR AGENCY (check one)
APHIS/PPQ
SURVEYOR NAME(S)
House/
APT
Number
Inspection
Complete
Y
Contractor
PAGE
OF
U.S. Forest Service
DATE
B
S
INFEST
C
P
Neg/Pos
G
K
Inv/Sus
N
OMB APPROVED
0579-0311
ACER Jap
(Maple) Acer
A
Y?
AESCULUS
(Horse
Chestnut)
BETULA SALIX ULMUS ALBIZZIA FRAXINUS
(Birch) (Willow) (Elm) (Mimosa)
(Ash)
H
B
S
U
Z
PLATANUS
(London
Plane)
F
L
POPULUS Cotton SORBUS KOELREUTERIA CERCIDIPHYLLUM
(Katsura)
(Poplar)
wood (Mt Ash)
(Goldenrain)
P
Y?
Mt
G
Kt
LOCATION
COMMENTS
DATE/TIME/INITIALS
B
F
C
SY
TOTAL
INSPECTION METHOD
B - Bucket truck
G - Ground survey
PPQ Form 375
FEB 2016
TREATMENT METHOD
C - Tree climb
S - Soil injection
D - Soil drench
INFEST
T - Trunk injection
N - Negative
P - Positive
TREE DESIGNATION
S - Suspicious
I - Inventoried
K - Park tree
S - Street tree
TREE LOCATION
P - Private tree
B – Back yard
C – Court yard
F - Front yard
SY - Side yard
File Type | application/pdf |
Author | Harris, Sheniqua M - APHIS |
File Modified | 2023-12-11 |
File Created | 2016-02-02 |