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23 0 V:'�ginia Aver
Dort I iercrv, FL 34982
772-462-2 72 Fax 772-462-6443
Cl�-RTIFIC,ATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
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PERN11T # AYM q a22 r.70B AC DRESS,/
BUILDER/CONTRACTOR:
PEST CONTROL CONTRACTOR:_
PEST CONTROL LICENSE #: 5 _
We, [he undersigned, hereby certify that we have pretreated the above described construction for
subterranean termites in $iccordance with the standards of the National Pest Control Association.
Square feet if area treated: Chemicals used: '
Percentage of solution' � � �d Total gallons used:
Date of Treatment; _ Time of Treatment: 19�-1. d
- Footing ___Siab
1"Treatment 1"Treatment
P,&Treat Re-Treat
Driveway Pools
151 Treacmer9t 1$t Treatment
�FT t
;ethe {�pJJ Perimete for Inspection
r
1"Treatment �
Re-Treat —
�` Signatur o
rminator
ere must be 5 ceImpleted form For each -e ulrred treatmenr nr re-treatment and this form must be on the job
Picked up by the Aspecror at time or each inspecrIon or the scheduled jr.5peCfion will fail and a r2-ln5pertlor
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i tax r z G-ia,g2d
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F F&C104z' b_'Gefdf-care of,°rotect&e Treatment fi-)r revarntion of termites. A weathor res&tanrjobstte posting board
6Al ed-ro recerve y(Up//C-are Trearrlenr cep Ificstes as each required protective treatmenCi cnrl)p/eteq,
^rc�L�a rrg a�cppyfor;the person the permit '.T 1y.sued o and,mother copy for the bullding permit f1le5. The Treatment
Cemrr�ate shall10rovide the producr Used, identIO o the appilcotcr, time and date of the treatmon� site location area
...
F r zatc; ehcrGi used, percont cvacc„trath)n and number vrgallons used, to establish a verifiabl,,record of
a ,��ote trk� t atrrient, =!f soil chemical b.�,rricr met nod for ternllto prejq,ntion is used, Anal eater%or trcatment shall
c!Xtia�a;rpletc 1prlOr"to bW'ding approi- 7.
SteL�cre County �e4uir05 for the final insp ction for Co, a permanent Sticker to be Placed aced
Iactrical.panel bON covert iistln�g a�i [he tre2ltrrientF_;3nd d on