"Notice of Termiticide Application" - Delaware

This "Notice of Termiticide Application" is a document issued by the Delaware Department of Agriculture specifically for Delaware residents with its latest version released on September 2, 2001.

Download the up-to-date fillable PDF by clicking the link below or find it on the forms website of the Delaware Department of Agriculture.

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Download "Notice of Termiticide Application" - Delaware

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NOTICE OF TERMITICIDE APPLICATION
For the purpose of complying with the Rules and Regulations of the Delaware Pesticide Law (3 DEL. C.,
1
Chapter 12), Notice
is hereby given to the undersigned that the property described above was treated
with a termiticide in the following manner:
Property Location
Termiticide:
EPA Reg. No.:
Actual Volume Applied:
Concentration
(Total Gallons)
(% Active Ingredient)
Dates of Application
Treatment of the property was at less than prescribed termiticide label concentration.
Treatment of the property was less than the volume (gallons of termiticide) prescribed by the termiticide label.
Treatment excluded areas of treatment prescribed by the termiticide label.
The termiticide application differed from the prescribed label application due to the following conditions:
Full Label concentration and/or volume could have
This is a retreatment of a limited area where termites
resulted in the following adverse environmental
have been found to be active.
impact:
Structural barriers existed that limited access to
Customer requested less chemical than prescribed by
applicable soil treatment areas.
label.
Customer Initials:
Structural barriers or soil conditions or soil types
Certified applicator recommendation of less chemical than
existed that prohibited application at full label
prescribed by label. (See statement on reverse side and
concentration or volume.
any additional comments below.)
Comments:
Customer’s Name or Agent
Title
Date
Company Name
Signature of Certified Applicator
Date
Attachments:
1. A diagram of the structure identifying treated areas and any sites of visible termite activity.
2. A copy of the termiticide product label
(Required upon customer request) .
(or, if no warranty guarantee, or service
3. Terms and conditions of any guarantee, warranty, or service agreement
agreement is provided, a statement to that effect) .
1
Label rates are specified by individual termiticide product labels and include concentration, volume, and locations of treatment for termite control. All preconstruction
treatments must be preformed at full label volume and/or concentration. This notice shall be provided to the customer within 14 days of any termiticide
application. A copy of this record shall be retained by the applicator for a period of two (2) years from the date of application.
Delaware Department of Agriculture
Original -
Customer Copy
Pesticide Section
1 -
Applicator Copy
2320 South DuPont Hwy., Dover, DE 19901
2 -
Duplicate File Copy
(800) 282-8685 (DE Only) or (302) 698-4500
Document # 65-01-06/01/09/02
NOTICE OF TERMITICIDE APPLICATION
For the purpose of complying with the Rules and Regulations of the Delaware Pesticide Law (3 DEL. C.,
1
Chapter 12), Notice
is hereby given to the undersigned that the property described above was treated
with a termiticide in the following manner:
Property Location
Termiticide:
EPA Reg. No.:
Actual Volume Applied:
Concentration
(Total Gallons)
(% Active Ingredient)
Dates of Application
Treatment of the property was at less than prescribed termiticide label concentration.
Treatment of the property was less than the volume (gallons of termiticide) prescribed by the termiticide label.
Treatment excluded areas of treatment prescribed by the termiticide label.
The termiticide application differed from the prescribed label application due to the following conditions:
Full Label concentration and/or volume could have
This is a retreatment of a limited area where termites
resulted in the following adverse environmental
have been found to be active.
impact:
Structural barriers existed that limited access to
Customer requested less chemical than prescribed by
applicable soil treatment areas.
label.
Customer Initials:
Structural barriers or soil conditions or soil types
Certified applicator recommendation of less chemical than
existed that prohibited application at full label
prescribed by label. (See statement on reverse side and
concentration or volume.
any additional comments below.)
Comments:
Customer’s Name or Agent
Title
Date
Company Name
Signature of Certified Applicator
Date
Attachments:
1. A diagram of the structure identifying treated areas and any sites of visible termite activity.
2. A copy of the termiticide product label
(Required upon customer request) .
(or, if no warranty guarantee, or service
3. Terms and conditions of any guarantee, warranty, or service agreement
agreement is provided, a statement to that effect) .
1
Label rates are specified by individual termiticide product labels and include concentration, volume, and locations of treatment for termite control. All preconstruction
treatments must be preformed at full label volume and/or concentration. This notice shall be provided to the customer within 14 days of any termiticide
application. A copy of this record shall be retained by the applicator for a period of two (2) years from the date of application.
Delaware Department of Agriculture
Original -
Customer Copy
Pesticide Section
1 -
Applicator Copy
2320 South DuPont Hwy., Dover, DE 19901
2 -
Duplicate File Copy
(800) 282-8685 (DE Only) or (302) 698-4500
Document # 65-01-06/01/09/02
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