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"Considering Your Environment"
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State License Number 114708
1119247th Road North Royal Palm Beach, FL 33411
561-333-8777/FAX 561-333-8999/Toll Free 866-414-PEST
Property Information
Subdivision: I` t 4 Lot: Block: Section:
Address �J� T(i'. �"'� 17 Y�-
City&Zip
Owner
Builder/Contractor Information
Name of Builder: l^n—
Shell Contractor: !
Construction Type
Monolithic: �_ Floating/Stemwall: Patio: Entry:
Driveway:
Addition: Other:
Product 1 Treatment Information
Treatment Date: g f Time: I C c Technician: —
Treatment Type(must ch k one) Initial Under Slab: Supplemental:
Product A pplied: Cypermethrin: Premise 75
Other T X
Concentration: % Mixed Product Applied: Gallons
Square Footage Treated: ) ` Ga Linear Feet Treated:
If this 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. TREATMENT IS IN ACCORDANCE WITH THE RULES AND
LAWS ESTABLISHED BY THE FLORIDA DEPARTMENT OFAGRICULTURE AND CONSUMER SERVICES.
(Florida Building Code(FBQ 1816.1.7)
Applicators Name (Please Print) Com/