HomeMy WebLinkAboutNew Construction Termite Service 1-29-18ti
AMERON HOMES
P.O. BOX 780874
SEBASTIAN, FL 32978
772-589-1299 PHONE 1 772-589-1304 FAX
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Now Construction Subter"I.-!9an Tarmhe
Service Record
�f � j V ! � OM8 Approval N . 2502-0525
(axp, 05/30/2018)
This form is Completed b the licensed Pest Control Company
Pubi9c reporting burden for this collec On of information is estimated to average 15 minutes per response, including the time r reviewI I I instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This information
ils required to obtain benefits_ HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.
Section 24 CPR 200.926d(b)(3) requires that the sites for HUD Insured structures must be free of termite hazards. This information collection requires the
builder to certify that an authorfzad Pest Control company performed all required treatment for termites, and that the builder guarantees tha treated area
against infestation for oneyear. Builders, past control companies, mortgage lenders, homebuyers, and HUD as a record of treatment for specific homes will
use the information Collected, The information Is not considered confidential, therefore, no assurance of confidentiality is provided.
This report is submitted for informational purposes to the builder on proposed (new) construction cases when treatment for prevention of subterranean termite
infestation is Specified by the builder, architect, or required by the lender, architect, FHA, or VA.
All contracts for services are between the Pest Control company and builder, ur
Section 1, General information (Pest Control Company Information)
Company Name: Ameron Pest Control
Company Address �� 9 s easy St.
Company Business License No. JB191692
FHA/VA Case No, (if any)
Sectloo 2: Builder Information
Company Name
Section 3: Property Information
Location of Structure (s) Treated (Street Address or Legal Description,
Section fir Service Information
Uate(s) of Service(s) _ i 1. 5 l`
Type of COn5ff116tion (More than one box maybe checked)
Chock all that apply:
A. Soil Applied Liquid Termlilc;de
E] Slab
Brand Name of Termiticide: Crosscheck plus EPA Regist
Approx. Dilution M:.12 Approx. TOM Gallons Mix Applied;
s, Wood Applied Liquid Tarmiticide
Brand Name of Termiticide: SPA Regist
Approx. Dilution M: _ Approx. Total Gallons Mix Applie
—1 C, Bait system Installed
Name of System EPA Registration No, _
D. Physical Barrier System Installed
Name of System Attach Installation info,
Service AgreementAvaflable? Yes No
Note: Some state taws require service agreements to be issued. This form
Attachments (List)
Comments
NameofApplioator(s) Matthew Helton
The applicator has used a
regulations.
Authorized Signature
accordancd with the product label and
Warning, WUD will prosecute false claims and stxlamenta. Conviction may result in
a stated otherwise.
Sebastian
_ Company Phone No.
_State FL. Zip 32958
772-385-8828
Phone No.
State and Zip)
a Basement El Crawl Mother i i V�
No. 279-3204-10404
�- Treatment completed on exterior: Yes E] No
No.
Number of Stations installed
(required)
not preempt state law. JAN 2 9 2018
Certification 140, (if required by State law) JE2O9O98
requirements, All materials end methods used comply with statue and faderml
Date _ I Ld� ! I �;
andlor elvit penaitisa, (18 U.B,c. 1001, 1olp. 1012; 31 U.S.C, 3729, 3802)
form HUD..MPMA-99.8