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OCCUPANTS FUMIGATION NOTICE & DISCLAIMER …

OCCUPANT S FUMIGATION NOTICE & DISCLAIMER DOCTOR fume , INC. 24-Hour Telephone No: (714) 938-1243 Fax No: (714) 938-1247 OCCUPANT S FUMIGATION NOTICE AND PESTICIDE DESCLOSURE JOB ADDRESS _____ CITY _____ [ ] Single Family Dwelling [ ] Multi Family Dwelling [ ] Other _____ Owner/Agent _____ Tel. No.: ( ) _____ Emergency No.: ( ) _____ Occupant _____ Tel. No.: ( ) _____ Emergency No.: ( ) _____ Prime Contractor _____ Emergency No.: (714) 938-1243 FUMIGATION Contractor: DOCTOR fume , INC. Emergency No.: (714) 212-6740 (Pager) Target Pests: [ ] Dry wood Termites [ ] Beetles [ ] Other(s) _____ Fumigants proposed to be used: [ ] Master fume (Active Ingredient Sulfuryl Fluoride) Other(s) _____ CHLOROPICRIN WILL BE USED AS WARNING AGENT WITH EITHER FUMIGANT Dates of FUMIGATION : _____ Date changes/Alternative date: _____ Re-Entry Date: _____ Initials _____ Key at: _____ Return Key to: _____ IMPORTANT RE

occupant’s fumigation notice & disclaimer . doctor fume, inc. 24-hour telephone no: (714) 938-1243 – fax no: (714) 938-1247 . occupant’s fumigation notice and …

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  Fume, Notice, Disclaimer, Fumigation, Fumigation notice amp disclaimer

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