HomeMy WebLinkAboutBLD03-426-TERM.PDF09,04.03 15,41 FAX 7048211415 SHIRLET—DIVENS+- Z01
V MD ��{Iy�Vr• 1�Y. L,7VL'V.ILD
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New Construction Subterranean Termite
Soil Treatment Record
This farm is carrploted �z the lic"W4 pat Control Company
Public repostiag bards for this collection of isfor"wi0n is estimmed to average 13 minutes per rmutific, inctudmg the time far reviewing instructions, searching exisdng
data sources, p4wring and maintaining the dan needed, and corrpleting and reviewf4 the collection of inforrTw0m. This informwon is mandatory and is squired to
obtain benefits, HUD may m collect this infort mr1m, and ytha arc not rerqutrW x complete this fiafm, unless it display a currently valid OMB control number
Section 24 CFR 200,926d(b)(3) requires that the since for HUD insured sanicWM must be free of termite hazards. this adom atiou collectoo requiem the bualder to certify
that rm atthorimd Fmi Canhvl c nNwTy peffornried ail required treatment far terrmi a. and that the builder parnmes the heated am s8atnrt mfem ran for one year.
Builders, past r mmil conepardea, mortgage leaders, bomcbuyers, anal HIM ag s record of tmat mcrt of spncifc bornes will nss dw inforTmooz collected.
This infomwtim is not considered confidential,
This rrport is subrnitlrel for inim+nanonal purposes to the builder or proposed (new) :.orntnction eases wher. gait treatment for prcvenc on of subterranean tcrwirr
infestation is spexified by the builder, srebitect, or required by the lender, architect, MIA, or VA.
All contracts far cervices we between the Pest (Amtrol Opmaior and builtkr, unless stated ohcrwisC
Seetka 1: GcmwW Wermatten (T.•eaft CuaVmy Iafomailon)
CouphnyNunn: KILLINGSWORTRENMONMNTAL
CoahpaayAddmss: 206 PARK ROAD RA.ST City: INDIAN TRAa. State: NC Zip: am
COMWy BuamwA License. No. 13t13 PW Corrtpttety Phone No.;
FHANA Case No. (if shy): _
&action I. pet MW lePormadism
Company Name: SUMEMOOD RQ2 fL%L j a, Phone No.:
Section 1 Pmp" lalis udom
Location of Structure(s) Treated (Street Addreae, or Lcpd Doscription, City, State and Zip):
3774 t.ORDON 3T TERR LL, NC AM
Type of Constromon : Slab Basomrnt Crawl YaQther
(More then atte box may be clacked)
Appro>.invo Dapdt of Foods, Outside: l 1 inside: 1-2 Type of Fill- DIRT
Seetioa 4: Treabsout lotarmapoa
DMKJ) of Tres tru I L tr1f2A03
areal Nurc of Pmduet(s) Used; ialdaeloprid EPA RAgNtratioo No..
AMMIeutate Final Mtx Solution %: 43
Sq. IL fN Lnwu R: Liner It of Ntattanry Voids:
Approxil I tc TO011 Crsllats of Solut im Applied: 33
Was aamwit completer! as exlerioO
Swiee Averment Avoilsbie: Ya
NOW; Srmro state laws require saviee sgrCemr its to * issued. This form does not prearmt state law.
Attaehw"m (List): E=n )1PCA 99a,Wn, r�i armvine asssain R Ckmeni hse Cgttrot Poiieyr
co+m au:
Namc of AppligUor(s)Victor Martfaea
Certification No. (iF REQUIRED BY STATE LAW)t_
The appitcator has toed a prnduat in aeeord&WA vnth the prat label sad ttwe tequiremcnts p1l treas,xnt rratm-41s UW tnethorls used comp'), with state and fedcnl
regulauoos.
Audnruod Siptatyrc=
warsirm Law tsreaec yr.e ctidw and stage L%0 oa•iterlee may rreDh in erlmlDal aaeVer ciyj gsakh.. (t! l:.S C raU1.101 1211 [I S.C' 77'.9. 33011
Famu VA 26-8375 and HUD-92052 are obsolete form HUD-NPC:A-99R (09/2002)