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I.l :1.1 @i1 I'r 1'•J.Yl I.r.,r I X�,ly - I INITIAL SERVICE I REGULAR SERVICE I EXTRA SERVICE TERMIPT/W :1 ii t1 r.I ? :1 T• L.0 E.::{f- FT' ro i.e T. {{: COMMERCIAL SERVICE AND • REPORT 3RANCIW. ACCOUNT." ... FtT, TELEPHbNE G91D Sr=DAY„ F. 7 ..:PAO�UCfION': n T'IIiIIE IN " } j bTIME OUT`. )1. :ri•t�):� f {Y.5 '••09 4 .;2n',::-....,.1,.•^:r:•, ::>">cJc;•. ,r MFT # (5il 'l O :}/rlc? ft t`.?h..:l.•::x=5 611 0" •'?'6"'.5 i r:�+ :!. 1"I i vary'SERVICE:I 'if QTY AT,a: �u ' $a � _.. . . .if:::f...T,r, f=11''f1R-1-r`tl::.i',t y ^ H SAN :.iOsAiXl.!:I:t� ty.{.. '32.-.' {, t (;: �E I ..�� ...,t`1� iii: f.. S , :?T01:::f<: (:.i Nr t:.'A 9•`i2 fY ( J ['.A t'r _i y( <209 )46-1. ....;.°-2 )PERATOR NAME&CERTIFICATION NUMBER SUPERVISOR NAME&CERTIFICATION NUMBER arget German Cockroaches ❑Pavement Ants Q Rats Occasional Invaders Materials 4 Used #Used tests merican Cockroaches El Argentine Ants ❑Mice ❑Stored Product Pests 450 Insiders 620 WIND-UP TRAPS ❑Oriental Cockroaches ❑Fire Ants ❑Silverfish ❑Other 400 Insect Monitors 610 T1N CATS ❑Other Cockroaches ❑Other Ants ❑Flies ❑Other 410 Pheromone Traps 645 Rat Bait Stations 600 Glue Traps 640 Mouse Bait Stations lest Control Materials Used EPA Reg.# T/C EIC Amount 630 Snap Traps 655 Liquid Bait Stations 293 Advance Granular Ant Bait(Abamectin BI)0.011% 499-370 Areas Inspected and/or Treated 295 Advance Dual Choice Ant Bait(Abamectin 61)0.011% 499-496 Pest Control materials used indicated by codes from lis:at left. 315 Ascend Fire Ant Bait(Abamectin,B1)0.011% 499-370 ood Areas -_ �� •�Er -� _309 Avert Roach Bait Stations(Abamectin)0.05% 499-467 365 Advance 388B Ant Gel Bait(Borax)5.4% 499-492 Dining Areas .2- 100 Bard Dust(Orthoboric acid)99% 9444-129 ❑Offices i 15 Demand CS(Lambda-cyhalolhrin) ❑0,015% ❑0.03% 110-1 100-1066 ❑Public Areas 219 DeRaGard G(Deltamethrin)0.05% 432-836 El Rest/Locker Rooms 158 TrlDie Bulk Dust(Silica Gel)40%{Pyrethrins)1.0% 499-429 ❑Display Areas 41 Gentrol EC{Hydroprene)0.06% 2724-351 540 Generation Mini Blocks Bait(Difethialone)0.0025% 7173-218 ❑Laundry/Boiler Room 541 "Generation Blue Max Blocks Bait(Difethialone)0.9025% 7173-236 ❑Storage/Utility 542 _ First Strike Soft Bait(Difenthialone)O.D025% 7173-258 ❑Warehouse Area 39 Intice Granular Bait(Ortho otic Acid)5.0% 73079-2 ElProcessing Areas 43 Kicker EC(Pyrethrins) ' 0.05% 17101% ❑0.2% 432-1145 ❑Patient Rooms 550 LiquiTox II Bait(Disodium Salt of Oiphacinone}D.106% 12455-61 Guest Rooms 352 Maxforce FC Roach Bait Stations(Fipronil)0.05% 432-1257 `r' ,i 351 Maxforce FC Ant Bait Stations(Fipronil)0.01% 432-1256 ❑,Basement 357 Maxforce FC Ant Gel Bait(Fipronil)0.001% 432-1264 ❑Roof 354 Maxforce FC Select Roach Bait Gel(Fipronil)0.01% 432-1259 ❑Exterior Perimeter 355 Maxforce FG Insect Bait(Hydramethylnon)1.0% 432-1262 ❑Landscaped Areas 359 Maxforce Magnum Bait(Fipronil)0.05%. 432-1460 ❑Loading Dock/Dumpster 151 PT Cy-Kick Aerosol(Cyfluthrin)C.1°/ 499-470 17 Other 70 PT Cy-Kick CS Ci 00.0075% Ell 0.050A ❑03% 499-304 er.'� r ��7 312 PT Avert Gel Bait{Abamectin B1)0.05-A 499-410 Precautions . .. Keep out of reach of children and pets, fig PT 565 Plus XLO Aerosol(Pyrethrins)0.5% 499-290 May cause eye.nose,throat,or skin irritation. 159 PT Tril Aerosol(Silica Aerogel)4,8%(Pyrethrins)0.6% 499-385 Avoid breathing vapors mists,or dusts.Harmful if swallowed. 61 Tempo Ultra WP(Cyfluthrin) ❑0.025%"❑0.05% 1710.1% 432-1304 Dampen granules to activate. Cc not tamper with rodenticidelacements. 83 Tempo SC Ultra(Cyfluthrin) E10.025% ❑0.05% E10.1% 432-1363 Do not return to room until allerventilation. 91 ULD BP 100 ULV(Pyrethrins)1.0% 499-452/11540-9 Dc not touch treated areas until dry. 92 ULD BP 300 ULV(Pyrethrins)3.0% 499-450/1154G-1 For flea treatments,remain off treated area for a minimum of four tours or until dry. 591 Weatherblok XT Bait(Brodifacoum)0.005% 100-1055 Treatment Cods(f/C}:C=(i&Crevice V-void 4=General S-Spot ST=Balt DC=Directed Contact B=T Band SP=Space IN=Inspection Equipment Code(E1C): Cs=Comp.Alr Sprayer T=Trap 6S=Bait Station HD=Hand Duster A=Aerosol BG=Bait Gun PT=Power Treatment F=ULV Posting Service Sticker? ❑Yes ❑No SMpervisorrs C(�n tents: I:f :1 r n� Tf�...� :,�;' '?rrs fr tL`�zSP.ECI;WL�S6FiV1GE-jN."STRUETPOI�S �w:a`r�ta`,t. �'�<. v ':. + ..' e..3'-' 4- 11\4(::!...t.!F3f:::::: :I.:? t.!NI•r•2: 'T,id'r'I:::I-,:I:0R i+4 A1-f-.. C:t:l31Mi:lN F-'{:::A;:i Of::. *12 :USTOMER'S SIGNATURE AMOUNT PAID r E1 l:. ;#. ! t�,r , L33 , ()r,.}i NICD IG TORE D E GAUNRESOLVED PAOB 4 cNgic` CALL 1-800-TERMINIX 1(1-800-837-64641 C TOMER'S COPY