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H'�LETT Termite Treatment
enviironznental
SCrV1CC8
7670 Okeechobee Blvd., West Palm Beach, FI. 33411
Phone: 1-800-285-7378
Fax: 561-684-0122
Property Information
Builder/Contractor
Treatment Date Time Q
Lot Block
Name of Builder
Subdivision Name
}G Casslq
Shell Contractor
Address (If known)
T_Street
Construction Type
OMonolithic OFloating/Stemwall []Pa-
City State Zip
-_rrlh6L va_ Y G
do
ClEntry m6riveway ❑Other:
Owner's Name (If kno )
Product/Treatment Information
Treatment Type: ❑ Underslab
LJ Patio/Driveway/Entry ❑ Final
❑ Wood Treatment
❑ Bait System ❑ Other
Product: ❑ Disodium Octaborate
❑ Cypermethrin
❑ Imidacloprid
❑ Bifenthrin
❑ Permethrin
�/ r I
EJ Other: F 12 oIry � II
Concentration ► 66
Mixed Product Applied -0
Square Feet Treated `l d
Linear Feet Treated �~
13 If this box is checked, then Final Perimeter treatment has
been completed and the following statement is applicable:
Certificate of Compliance: This building has received a complete treatment for the prevention of
subterranean termites. This treatment is in accordance with the laws and rules established by the
Florida Department of Agriculture and Consumer Services.
i� 7
A plicator's Name (please print) Applicator's Si afore
HES-TE019 07/19 Hulett Envirown ntal Services® 2019
II -
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