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'Considering Your EnvironmenC
State License Number 14708
11192 47th Road North Royal Palm Beach, ,FL 33411
661-333-8777/FAX 561-333-89991 Toll Free 866-414-PEST
Property Information
Subdivision:i— (' C �— Lot: Block: Section:
Address �--
City&Zip
Owner
Builder 1 Contractor Information
Name of Builder. dri
Shell Contractor.
Construction Type
Monolitiiic: Floating/Stemwall: Patio: 'Entry.-
Driveway. il
Addition: Other
Product 1 Treatment InfdrmWon
Treatment Date: Time: Technician:
Treatment Type(m ich one) Initial Under Slab:_Supplemental:.:
Product Applied: Cype nn: Premise 75 Other -
Concentration: T _OZo ixed o ct Applied: `7 , L/ Galion
Square Footage Treated: ear Feet Treated:
If this is chechwd, they?finl polinWor treatirtre4d has lwcv Co fi)! te(I afid Ilia
following statemont is app icab o:
Certificate of IiQmpIWCS:THIS BUILDIAIG HAS f:ECERIE-D A COXPLE-TE Tf EWHEAT FOR THE
PREVENTIONOFSUBTERRANEANTERMITES TREATMENTIS/NACCORDANCEWITHTHERULESAND
LAWS ESTABLISHED BY THE FLORIDA DEPARTMENT OFAGRICUL TUREAND CONSUMER SERVICES
(Florida SuMing Code(FSC)1816 t 7)
i
Applicators Name(Please Print)
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