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