HomeMy WebLinkAboutTERMITE TREATMENT CERTIFICATEPre -Construction secAmmED
Ia'�7LETT Termite Treatmenfl"Oecbum
cnvironxnenial
services
7670 Okeechobee Blvd., West Palm Beach, Fl. 33411
Phone: 1-800-285-7378 Fax: 561-684-0122
Property Information
Treatment Date 1Q 1! � Time ` '
Pot Block
ecoi i- -# l (?OR -
Subdivision Name r
6461t l-i;cFiory Dr
_Street Address (If known)
Builder/Contractor
Name of Builder
Shell Contractor
�0C� C L 31AIkVL Construction Type
City State Zip []Monolithic []Floating/Stemwall []Pa-
- _[�h Mosetcy do
_Owner's Name (If known) I []Entry []Driveway []Other:
Product/Treatment Information
Treatment Type: F Underslab ❑ Patio/Driveway/Entry ❑Final
❑ Wood Treatment ❑ Bait System ❑ Other
Product: ❑ Disodium Octaborate ❑ Cypermethrin
71midacloprid 0 Bifenthrin
❑ Permethrin ❑ Other:
Concentration
Square Feet Treated / O _
Mixed Product Applied 2 G4
Linear Feet Treated
❑ 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.
�)LIS,r(1 ��
Applicator's Name (please print) / - licatnifs-Signature
HES-TE019 08116 // Hulett Environmental ServicesJ:2016