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Notice of Preventative Treatment for Termites
(as required by Florida Building Code(FBC) 104.2.6 and Broward County Chapter FBC 105.2.2)
PEST PREVENTION I FIRE ANT SERVICE I TERMITE SERVICE I RODENT EXCLUSION&REMOVAL I WHITEFLY TREATMENT
DATE OF SERVICE I t TIME
DEVELOPMENT NAME(PROJECT) CONTRACTOR'S NAME CONTACT PERSON
STRUCTURE ADDRESS.(LOTIBLOCK)I CITY,STATE _ \i•yCOUNTY
NOTES ZIP CODE
-;
TREATMENT TYPEIAREA
❑FLOATING ❑MONOLITHIC ❑PATIO ❑GARAGE ❑DRIVEWAY ❑STEM WALLIFOOTERS ❑ADDITION
❑CUTOUTS ❑FOOTER ❑FRONT ENTRY ❑RETREAT ❑BORA CARE TREATMENT ❑PLUMBING CUT OUTS ❑SIDEWALKS
❑TAMP&TREAT ❑TREAT ONLY ❑FINAL ❑POOL DECK ❑OTHER
PRODUCTS
❑BASELINE Ij DOMINION 2LACTIVE INGREDIENT ❑TERMIDOR SC ❑BORACARE ❑PREMISE ❑TALSTAR
❑OTHER
ACTIVE INGREDIENT - ❑IMIDACLA?RID ❑BIFENTHRIN ❑DISODIUM OCTABORATE-TETRAHYDRATE
CONCENTRATION
❑.06% .❑.1% ❑.12% ❑,25% ❑.05% ❑23% ❑9% ❑OTHER GALLONS APPLIED
SQUARE FOOTAGE LINEAR FOOTAGE
SQUARE FOOTAGE VERIFIED
❑,YES ❑NO ❑.MEASURED OR VERIFIED PER PLANS
JOB READY CONDITIONS MET
❑YES ❑NO DETAILS
As per 104.2.6 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:The Bug Assassins,LLC
Date Customer(Property Owner or Agent)