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Notice of Preventative Treatment for Termites
(as required by Florida Building Code (FBC) 104.2.6, 1A5.10 & R318.1 and Broward County Chapter FBC 105.2.2)
PEST PREVENTION- I FI E ANT SERVICE I TERMITE SERVICE I RODENT EXCLUSION & REMOVAL I WHITEFLY TREATMENT
DATE OF SERVICE I LJ' TIME I Z C CJ
I
DEVELOPMENT NA (PROJECT) CO3(V� �� OR'S NAME� � G � i � � CO
TACT PERSON 2 L �a
-I G� 'VJ' Y C 7 1 G
STRUCTURE ADDRESS (LOT/BLOCK) CI• STATE COUNTY
NOTES ZIP CODE
TREATMENT TYPE/AREA
❑ FLOATING
❑.MONOLITHIC 0 PATIO
❑ GARAGE ❑ DRIVEWAY
❑ STEM WALLIFOOTERS ❑ ADDITION
b/CUTOUTS
U TAMP & TREAT
❑ FOOTER ❑ FRONT ENTRY
TREAT ONLY . ElFINAL
❑ RETREAT ❑ BORA CARE TREATMENT
❑ POOL,DECK ❑ OTHER
U/PLUMBING CUT OUTS ❑ SIDEWALKS
PRODUCTS
❑ BASELINE
!
® DOMINION 2LACTIVE INGREDIENT
❑ TERMIDOR SC ❑ BORACARE ❑ PREMISE
❑ TALSTAR
❑ OTHER
ACTIVE INGREDIENT _ IMIDACLAPRID ❑ BIFENTHRIN ❑ DISODIUM OCTABORATE TETRAHYDRATE ;.
CONCENTRATION
❑ .06% ❑ .1% ❑ .12% ❑ .25% / .05% ❑ 23% ❑ 9% ❑ OTHER
SQUARE FOOTAGE C/ LINEAR FOOTAGE
SQUARE FOOTAGE VERIFIED
0 YES ❑ NO
]MEASURED OR VERIFIED PER PLANS
JOB READY CONDITIONS MET
t YES I❑ NO
DETAILS
GALLONS APPLIED
"Certificate of Compliance"
As per 104.2.6,105.10 & R318.1 FBC -'If soil chemical barrier method for termite, prevention is used.
Final exterior treatment shall be completed prior to final building approval.
Certificate of Compliance: The building has received a complete treatment for the prevention of subterranean termites. Treatment is in accordance with rules
and laws established by the Florida Department of Agriculture and, Consumer Services. (Per the Florida Building Code.)
If this notice is for the final exterior treatment, initial and date this line '
FINAL STICKER
❑ ELECTRICAL PANEL ❑ WATER HEATER
`i'; Pavme'rit Terms Payment due at time of service.
Date'
❑ OTHER
Date Customer (Property Owner or Agent)
tt
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