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13
City of Pleasanton
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CITY CLERK
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AGENDA PACKETS
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2016
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090616
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Last modified
11/30/2016 1:49:21 PM
Creation date
8/31/2016 3:01:46 PM
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CITY CLERK
CITY CLERK - TYPE
AGENDA REPORT
DOCUMENT DATE
9/6/2016
DESTRUCT DATE
15Y
DOCUMENT NO
13
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13 ATTACHMENT 3
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\CITY CLERK\AGENDA PACKETS\2016\090616
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20th <br /> PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT: <br /> 4791 Augustine Street, Pleasanton CA 94566 11/3/2015 6613 <br /> BUILDING NO STREET.CITY,STATE,ZIP INSPECTION DATE REPORT NO. <br /> OCCUPANTS CHEMICAL NOTICE <br /> John Taylor Termite Company will use pesticide chemical(s) specified below for the <br /> control of wood destroying pests or organisms in locations identified in the <br /> Structural Pest Control report as indicated above. <br /> (1) The pest(s) to be controlled: <br /> X SUBTERRANEAN TERMITES X FUNGUS or DRY ROT <br /> BEETLES _ DRY-WOOD TERMITES OTHER <br /> (2) The pesticide(s) proposed to be used and the active ingredient(s). <br /> X A. PREMISE 75 WP EPS 3125-455. CHLORONICOTINYL 1-((6-CHLORO-3-PYRIDINYL <br /> ((METHYL))1-N-NITRO-2 IMIDAZOLIDINIMINE. <br /> IMIDACLOPRID;BAY NTN 33893 C9 H10 Cl N5 02 <br /> X B. TIM-BOR INSECTICIDE EMERGENCY PHONE 24HR 800-228-5635-EXT.144 <br /> EPA 1624-39 99% DISODIUM OCTABORATE TETRAHYDRATE <br /> C. TERMIDORgSC EPA 432-TX-1 ACTIVE INGREDIENT: FIPRONIL <br /> CAUTION PESTICIDES requires that CHEMICALS. Structul Structural Pest information:Operators are <br /> licensed and regulated by the Structural Pest Control Board, and apply <br /> pesticides which are registered and approved for use by the California <br /> Department of Pesticide Regulations and the United States Environmental <br /> Protection Agency. Registration is granted when the State finds that based on <br /> existing scientific evidence there are no appreciable risks if proper use <br /> conditions are followed or that the risks are outweighed by the benefits. The <br /> degree of risk depends upon the degree of exposure, so exposure should be <br /> minimized. <br /> "If within 24 hours following application you experience symptoms similar <br /> to common seasonal illness comparable to the flu, contact your physician or <br /> poison control center and your pest operator immediately. (This statement shall <br /> be modified to include any other symptoms of over exposure which are not <br /> typical of influenza.)" <br /> For further information, contact any of the following: <br /> John Taylor Termite Company (925) 757-6755 <br /> Contra Costa County Health Department (925 ) 313-6710 <br /> Contra Costa County Agriculture Commissioner (925) 646-5250 <br /> Poison Control Center (800) 523-2222 <br /> Structural Pest Control <br /> 2005 Evergreen Street Ste 1500 Sacramento Ca 95815 (800) 737-8188 <br /> Persons with respiratory or allergic conditions, or others who may be <br /> concerned about their health relative to this chemical treatment, should <br /> contact theepir physician gconcerning occupancy during and after chemical <br /> NOaCHEMICAL APPLICATIONis WILL BE PERFORMED UNTIL SUCH TIME THAT THIS NOTICE IS <br /> RETURNED. HAVING READ THE INSTRUCTIONS, I, THE UNDERSIGNED, WILL ACCEPT <br /> RESPONSIBILITY FOR ALL THE AFOREMENTIONED. <br /> 011 - • S U. . 1 - p , <br /> APPLICATOR DATE <br /> JOHN TAYLOR TERMITE COMPANY—License No. PR 3661 <br />
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