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HIGHLAND PEST CONTROL, Inc. JUN 1 9 2001
STATE LICENSE NUM8ER 3995
2771 Vista Parkway · Suite F10 · West Palm Beach, FL 33411,~J~~~c w
PHONE TOLL FREE FAX
(561) 793-1198 1~888-221~7740 (561) 791~2337
PRE-CONSTRUCTION SUBTERRANEAN TERMITE TREATMENT
,I
ADDRESS
LOT
CITY
BUILDER
SUB-CONTRACTOR
MODEL
~RESIDENTIAL -
COMMERCIAL
OWNERS NAME
MAILING ADDRESS
IF DIFFERENT THAN ABOVE
HORIZONTAL AREA TREATED:
HOUSE -
FRONT ENTRY-
PATIO -
ADDITION
OTHER
DA TE TREATED
TIME
TECHNICIAN
TERMITICIDE
AT
%
SQUARE FEET TREATED
TOTAL SQUARE FEET
GALLONS
LINEAR FEET
IF SOIL CHEMICAL BARRIER METHOD FOR TERMITE PREVENTION IS USED, FINAL EXTERIOR TREATMENT
SHALL BE COMPLETED PRIOR TO FINAL BUILDING APPROVAL. (FLORIDA BUILDING CODE 104.2.6)
DATE VERTICAL TREATED
TIME
TEClllNCIAN
LINEAR FEET
GALLONS
TERMlTICIDE
@
%
. ~Ii!.!". ~
ENTIRE VERTICAL
PARTIAL VERTICAL
DRIVEWAY
SIDEWALK
TYPE OF TREATMENT:
SOIL BARRIER
WOOD TREATMENT
BAITING SYSTEM
- IF THIS BOX IS CHECKED, THEN FINAL PERIMETER TREATMENT HAS BEEN COMPLETED AND THE
FOLLOWING IS APPLICABLE:
CERTIFICATÉ OF COMPLIANCE: TIllS Bun.pING HAS RECEIVED A COMPLETED TREATMENT FOR
THE PREVENTION OF SUBTERRANEAN TERMITES. TREATMENT IS IN ACCORDANCE WITH THE RULES AND
LA WS ESTABLISHED BY THE FWRlDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES.
(FLORIDA BUILDING CODE (FBC) 1816.1.7)
APPLICA TOR'S NAME (PLEASE PRINT)
FORM# 91-0