HomeMy WebLinkAboutNEW CONSTRUCTION SUB. TERMITE SOIL TREATMENT RECORDOMB Approval No. 2502-0525
New Construction Subte lean Termite 1
(exp. 11/30/2008)
Soil Treatment Record /Qx
This form is completed by the licensed Pest Control ComDa v ! [ v GZ<—%
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewhg'Tnstruellons, searching
existing date sources, gathering and maintaining thadata needed, and completing and reviewing the coilection of Information. This Information Is mandatory and Is
required to obtain benefits. HUD may not collect this Information, and you are riot required to complete this forth, unless It displays a currently valid OMB control
number.
Section 24 CFR 200.926d(b)(3) requires that the sites for HUD Insured structures must be free of termite hazards. This IMmr oation collection requires the buider to
verify that an authorized Pest Control company pedomted all required treatment for termites, and that the builder guarantees the treated area against infestation for
one year. Builders, pest 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. I '
This report is submitted for informational purposes to the builder on proposed (new) construction cases when soil 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
Section 1: General
Company Name:
Comparry Address
Company Business License No.
FHANA Case No. (if any)
and builder, unless stated otherwise.
OUAWNLU
St. Lucie County
State F(L Tip
Section 2: Builder Information /��J �j
Company Name Zc ylay n cz�., yl r��'�"'� r� Phone No. 7/Z "I I_3 _�O qD
Section 3: Property Information
Location of Structure (s) Treated (Street Address or Legal Description, City, State and Zip)
Type of Construction (More than one box may be cheecked) Slab ❑ Basement ❑ Crawl 7 Other
Approximate Depth of Footing: Outside f Inside Type of RII .SQ taA
Section 4. Treatment Intormation /J—/
Dater(s) of Treatment(s) 9 — _ - -
Brand Name of Product(s) Used 1'rnss r-�)ne '
EPA Registration No. 279-3266 — 0 "I O'lJ
Approximate Final Mx Solution % ,12
Approximate Size of Treatment Area: Sq. tL 2 ;'1 W
Approximate Total Gallons of Solution Applied ZD
Was treatment completed on exterior? M Yes No
Service Agreement Available? ® Yes ®No
Note: Some state laws require service agreements to be issued.
Attachments (List)
Comments
Name of Applicator(s) AmIogj�x C/ 7
Certification No. (if required by State law) L / (/ I66
The applicator has used a product in
state and federal regulations.
Authorized Signature
Linear ft.
Linear ft. of Masonry Voids
This form does not preempt state law.
and state requirements. All treatment materials and methods used comply with
Date 8 2 % /f
and
Forth NPCA-99-B may still be used form HUD-NPCA-99-B (04/2003)