Form FDACS-13667 "Notice of Fumigation" - Florida

Form FDACS-13667 or the "Notice Of Fumigation" is a form issued by the Florida Department of Agriculture and Consumer Services.

Download a fillable PDF version of the Form FDACS-13667 down below or find it on the Florida Department of Agriculture and Consumer Services Forms website.

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Download Form FDACS-13667 "Notice of Fumigation" - Florida

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Florida Department of Agriculture and Consumer Services
Respond to:
Division of Agricultural Environmental Services
Bureau of Inspection and
Incident Response
3125 Conner Blvd, Suite N,
NOTIFICATION OF FUMIGATION
Tallahassee, FL 32399-1650
Section 482.051(4), F.S. and Rule 5E-14.110, F.A.C.
ADAM H. PUTNAM
Telephone: (850) 617-7996 Fax: (850) 617-7981
COMMISSIONER
In accordance with regulations, each licensee, before performing general fumigation, shall notify the department at least
twenty-four (24) hours in advance of the fumigation period. Notification shall be made utilizing the department’s electronic
fumigation notification website http://fumigation.freshfromflorida.com or by submitting this form by facsimile.
Facsimile Number: (850) 617-7981
Company License No (JB):
Company Name:
Company Street Address:
City:
State:
Zip Code:
Fumigant Trade Name:
Active Ingredient:
Name of Certified Operator in Charge or SPID for this fumigation:
Day Phone Number:
Night Phone Number:
IF this job is subcontracted to you, who is
the CONTRACTING Company?
Street Address of Fumigation Location:
City:
State:
Zip Code:
County:
Primary Structure Type:
_____ Residential – Single Family
_____ Residential – Multi-Family
_____ Commercial Building
_____ Vault
Number of Structures to be Fumigated: _____
Date of Fumigation:
Target Pest:
Approximate Duration of Fumigation (hrs):
FDACS-13667 Rev. 03/17
Florida Department of Agriculture and Consumer Services
Respond to:
Division of Agricultural Environmental Services
Bureau of Inspection and
Incident Response
3125 Conner Blvd, Suite N,
NOTIFICATION OF FUMIGATION
Tallahassee, FL 32399-1650
Section 482.051(4), F.S. and Rule 5E-14.110, F.A.C.
ADAM H. PUTNAM
Telephone: (850) 617-7996 Fax: (850) 617-7981
COMMISSIONER
In accordance with regulations, each licensee, before performing general fumigation, shall notify the department at least
twenty-four (24) hours in advance of the fumigation period. Notification shall be made utilizing the department’s electronic
fumigation notification website http://fumigation.freshfromflorida.com or by submitting this form by facsimile.
Facsimile Number: (850) 617-7981
Company License No (JB):
Company Name:
Company Street Address:
City:
State:
Zip Code:
Fumigant Trade Name:
Active Ingredient:
Name of Certified Operator in Charge or SPID for this fumigation:
Day Phone Number:
Night Phone Number:
IF this job is subcontracted to you, who is
the CONTRACTING Company?
Street Address of Fumigation Location:
City:
State:
Zip Code:
County:
Primary Structure Type:
_____ Residential – Single Family
_____ Residential – Multi-Family
_____ Commercial Building
_____ Vault
Number of Structures to be Fumigated: _____
Date of Fumigation:
Target Pest:
Approximate Duration of Fumigation (hrs):
FDACS-13667 Rev. 03/17
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