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Notice of Preventative Treatment for Termites
(as required by Florida Building Code(FBC)104.2.6, 105.10&R318.1 and Broward County Chapter FBC 105.2.2)
PEST PREVENTION I FIRE,�(A�NTi SERVICE I TERMITE SERVICE I RODENT EXCLUSION&REMOVAL I WHITEFLY TREATMENT
DATE OF SERVICE �n t '`-v `` TIME ,v
DEVELOPMENT NAME(PROJECT) (1, „ I� CONTRACTOR'S
\�NAME CONTACT PERSON
STRUCTURE ADDRESS(LOTIBLOCK) (1� CITY,STATE C COUNTY C,
NOTES ZIP CODE
TREATMENT TYPEIAREA
❑FLOATING 2 ONOLITHIC ❑PATIO ❑GARAGE ❑DRIVEWAY ❑STEM WALUFOOTERS ❑ADDITION
❑CUTOUTS• LI DOTER ❑FRONT ENTRY ❑RETREAT ❑BORA CARE TREATMENT ❑PLUMBING CUT OUTS ❑SIDEWALKS
❑TAMP&TREAT O TREAT ONLY ❑FINAL ❑POOL DECK ❑OTHER
PRODUCTS - —
❑BASELINE 01DOMINION 2LACTIVE INGREDIENT ❑TERMIDOR SC ❑BORACARE ❑PREMISE ❑TALSTAR
❑OTHER /r
ACTIVE INGREDIENT EPIMIDACLAPRID ❑BIFENTHRIN ❑DISODIUM OCTABORATE TETRAHYDRATE
CONCENTRATION
❑.O6% ❑.1% ❑.12% ❑.25% 0705% ❑23% El9% ❑OTHER GALLONS APPLIED
SQUARE FOOTAGE 1, LINEAR FOOTAGE
SQUARE FOOTAGE VERIFIED
❑'YES ❑NO E EASURED OR VERIFIED PER PLANS
JOB READY CONDITIONS MET
0'Y/ES ❑NO DETAILS
i°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 ❑OTHER
Payment Terms: Payment due at time of service.
Date Applicator:(Evict Bug Termite and Pest Control,Inc.)
'''QP9I161W 0i
Date Customer(Property Owner or Agent)
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