**\[PARK NAME\] GRAVEL AND FILL INSPECTION**

**Field Inspection Report**

Inspector's name:

Inspection date:

Vendor's name:

Vendor's address &

telephone number:

Type of Material Inspected:

Location of Material:

**Pit Location** (if different from stockpile location):

Street Address:

Legal description:

(Sec.T.Rge.)

**Pit History**

Date product mined/crushed:

Length of time in stockpile:

Any herbicide treatment

(date/chemical name):

**Weed Inspection List** (State Listed Noxious Weeds)

**In Field** **Near Field**

Category 1: Y N \# Y N \# Comments

  ---------------------------------- --- --- ---- --- --- ---- ---------------
  Canada Thistle -- *Cirsium                                   
  arvense*                                                     

  Field Bindweed -- *Convolvulus                               
  arvensis*                                                    

  Whitetop - *Cardaria draba*                                  

  Leafy Spurge -- *Euphorbia esula*                            

  Russian Knapweed - *Centaurea                                
  repens*                                                      

  Spotted Knapweed - *Centaurea                                
  maculosa*                                                    

  Diffuse Knapweed - *Centaurea                                
  diffusa*                                                     

  Oxeye Daisy -- *Chrysanthemum                                
  leucanthemum*                                                

  Dalmation Toadflax *-- Linaria                               
  dalmatica*                                                   

  Sulfur Cinquefoil - *Potentilla                              
  recta*                                                       

  St. Johnswort - *Hypericum                                   
  perforatum*                                                  
  ---------------------------------- --- --- ---- --- --- ---- ---------------

Continued on following page...

Category II:

  ---------------------------------- --- --- ---- --- --- ---- ---------------
  Dyers Woad - *Isatis tinctoria*                              

  Purple Loosestrife -- *Lythrum                               
  salicaria*                                                   

  Tansy Ragwort - *Senecio jacobea*                            

  Orange Hawkweed *-- Hieracium                                
  aurantiacum*                                                 

  Meadow hawkweed comples --                                   
  *Hieracium pratense, floribundum,                            
  piloselloides*                                               
  ---------------------------------- --- --- ---- --- --- ---- ---------------

Category III:

  ---------------------------------- --- --- ---- --- --- ---- ---------------
  Yellow starthistle *-- Centaurea                             
  solstitialis*                                                

  Common Crupina - *Crupina                                    
  vulgaris*                                                    

  Rush Skeltonweed - *Chondrilla                               
  juncea*                                                      
  ---------------------------------- --- --- ---- --- --- ---- ---------------

Other non-native agronomic or weedy Species of Concern (list species and
describe extent of infestation/concern):

Comments:

Inspector signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Vendor signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_