ORKIN

PEST
CONTROL
OOWN
TOA
SCIENCE~
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Amount Paid _ _ _ _,~

'------
Date ~ Scheduled Date Prior Service 0 Cash
Time In ~AM @) D Check Ck# _ _ _ __
Time Out r;;J7 r ) AM l@

\.~~At: kMJ~
TYPE OF SERVICE
Pesticide Product Labels are Available Upon Request.
For additional information, a copy of the Label and/or MSDS D Regular D Call Back or Follow-Up D Start
CUSTOMER SlfNATURE
Follow Up Service Date
ARE vou sA11sF1Eo o~
TEC
J.trtt
ili~ LA
may be requested from your local branch.
'"-'
? ddJob D Extra Serv'ice

ENVIRONMENTAL INSPECTION INDICATES THE FOLLOWING CONDITIONS. (Explain "no" answers under comments) Treatment
A)Yea No NA SANITATION _Q) Tllll NO NA PW-MINloi Orkin takes care to place treatment materials where they will achieve maximum effectiveness. For codes, see other side.

~a
D D LI 1. Premises free of litter and debris? D 1. Drain covers present in good Target Af.pllcatlon Rate
Products Quantltv Sites Soeclfic Site Aoollcatlon Area fit aoolicablel Pest Method Eouloment •11 applicable)
D D ( I 2. Garbage containers cleaned and repair?
covered? D 2. Pipes free from broken insulation?
.
- .
, I .I I (\ ~
D DC 3. Elevator pit clean from litter and D 3. Pipes free from leaks?
......
A -
.LJ 11 ,,n
/ I J"' I.£# .. " - ~w.a-rtl"\61 ..u 1--..,{J I 0"'6.1:.
-·
("
debris?
..J.lV • , ~
} (, ,, }\ ~
- ,
D D Cl 4. Food preparation and storage _E) Yea...No..NA.AY. CONIROL /-....v r 4PF 11 IA J .ll\..,.j l\ <; L l l r I J /
equipment free from food debris?
D 0 ( I 5. Mops and brooms stored off floor,
D D ~ 1. Is fly control adequate?
0 0 2. Is odor control adequate? _, I J
/
/
I I ' /
/
VIX
..... --
/, I - ~ LJ- ,__..,
on racks? Wind Direction Wind Velocity Temperature
711"
/
·-
D D ( ~ 6. Restrooms clean, cl utter free?
D D ( l 7 . Locker I break rooms clean and ~ .. ~
CONSUMER NOTIFICATION(S) I POST APPLICATION STATEMENTS FOR INFORMATION REGARDING CODES LISTED ABOVE, SEE REVERSE SIDE
~
Treated Area(s) - Do not allow unprotected persons, children, or pets to touch, enter, or replace items or bedding, to contact or enter treated area(s) until dry.
accessi ble?
D D (J 8. Storage area clean and orderly? H
/ l/ i t ion Ventllatlon/Reoccupylng - Vacate and keep area(s) closed up to 30 minutes after treatment, then ventilate area(s) for up to 2 hours before reoccupying.

~~u~pwith~Y:;~~~~=:~i?~o~~:~J~~°a~g~~;~hd~~f~;~ t~~~7~~~f.~J>~~~=r:~~~g~:~~~:~f~~n:~dp~~~~~sa~~~~~~;~:r~~eaning compound and

B)Yea No NA STRUCTURE
D D (J 1. Exterior doors I windows rodent
'COMMENTS
Granular Application.Ls) - Do not waler to the point of run off. treatment.
I
Exterior Applications -(Baits) - Do not allow grazing of feed, lawn or sod clippings to livestock attar bait applications. Do not bum treated firewood IOI' 1 month atter
I insect proof?
D
D
0 (
0 (
2. Exhaust fans screened?
3. Walls I floors free from missing I
T \A~ oi.,4.,6 ~ t:l I o\l'L ,.,~_.._r ( ~ •• \ \ ,/).,. c--\ Com mere la I
Establishments
Previous
lnventorv
Number
Picked-uo
#Added Replaced/New New
CNo Charae lfCharoeablel + lnventorv Charae $
Equipment

D DO
loose I or broken tiles?
4. Holes sealed: walls, pipes, conduits {\ ~~ ....... - ~,\.)~ S-.svr-v--.. "' ~\" c, -f'vr., ,~4',.l'IL &ct Air Scents r-.... "--.
v
_,. !'..
_x "' ...........__ ... v
bolts, beverage lines, ceiling?
C)Yes Nol IA STORAGcP~TICES
0
~\~~r ~---- h~~ h~1...
.' '
I/\ ...s'u-- Cl Pr-I /,. J~r+I ,-..;
Exterior Bait Stations
Interior Bait Stations
"' v "" / ~
/'-...._
./
""'... .x....
/ ['.._

"' ""
D D ( 1 . Items stereo away from floor ana Multi Catch Traps
-~ N~
f ~
.I
walls? l\>-'fY'\. (\~.'\L I .\.D .NI _t'"").._.,..c \ _L d Orkin/Aires / "- ,.,....,,.. ......
!'-.../ '
D D ( ) 2. Can ned I bottled goods removed
v v -. . . . .
~"'-+'
~

~~
Insect Light Trap (ILT)
from cardboard?
D D ( J 3. Bulk food storage containers +.t>11 /) \ t_ \ lJ "'-.
lrlL
"'\" A.-6 Cp,('~-\ / " -
'i-....

covered? ....s:.. ,,,.,.J.. .,,_A I "'c, Aft(.) ~ ore\..£\~"""' -" Customer Initials l -II A
t
• ' 0 No activity reported. Preventive
treatment rendered for target pests.
0 German Roaches (GR) O Rats (RA)
ji!f rendered
Activity reg;rted. Treatment
O
or target pests below.
German Roaches (GR) 0 Rats (RA
0 American Roaches (AR) O Mice (Ml) O American Roaches (AR) 0 Mice (Ml
0 Oriental Roaches (OR) O Oriental Roaches (OR)
0 Carpenter Ants (CA) 0 Carpenter Ants (CA)
0 Fire Ants (FA) 0 Fire Ants (FA)
State Re uired Information: 0 Ants (Other) (AO) Q.tnts (Otha~~ \ t.1
O Other (On _ _ _ _ _ __ ,,,ia ·Other (On- -o d l::>Vtj2
AZ. - WARNING - PESTICIDES CAN BE HARMFUL. KEEP CHILDREN AND PETS AWAY FROM PESTICIDE APPLICATIONS UNTIL DRY, DISSIPATED OR AE RATED.
FOR MORE INFORMATION , CONTACT: ORKIN PEST CONTROL - C4029BCD AT 1-800-346-7546.
© 2011 Orkin LLC SVPC1007WLD Rev. (01/2018) This report does not include wood infesting organisms and/or mold or any mold-like conditions. National Poison Contro l Center (800) 222-1222
OFFICE COPY