34 DUDLEY ST - TERMITE TREATMENT prAAVERIft
1100 BLAST
P.O. Box 50367 • Jacksonville Beach, FL 32240
(904) 242-BUGS
MITE TREATM�1��CRTIFICATI®N
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Street Address: -
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City: County:
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General Contractor/Builder: Area Treated:
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Date: Time:
Name of Applicator: Active Ingredient:
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Product} Used:Active Ingredient%Concentration: Number of gallons used:
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a 1 Gf
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Method of termite treatment:
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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.
This form is proof of complete treatment for Certificate of Occupancy or Closing.
THIS IS PROOF OF WARRANTY
Warranty and Treatment Certifications Have Been Issued.
Authorized Signature: Date:
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