Monthly Report of Wood Destroying Insect Control Work

Mississippi Department of Agriculture & Commerce — Bureau of Plant Industry

Report Information

Company Name	#field(13395)
Physical Address	#field(13396) #field(13397) #field(13398), #field(13399) #field(13400)
Mailing Address	#if("#text(#field(13402))" == "Mailing address is same as physical address")Mailing address is same as physical address.#endif#if("#text(#field(13402))" != "Mailing address is same as physical address")#field(13403) #if(#field(13404))#field(13404) #endif#field(13405), #field(13406) #field(13407)#endif
Report Month / Year	#field(13409) #field(13410)
Licensee Name	#field(13411)
No Work Performed	#field(13412)

Termiticide Inventory

#section_rows_start(2233) #section_rows_end

Brand Name	Formulation	Beginning	Used	Purchased	End
#text(#field(13416))	#text(#field(13417))	#text(#field(13418))	#text(#field(13419))	#text(#field(13420))	#text(#field(13421))

Treatment Records

#section_rows_start(2236)

Treatment Record #calc(#section_row_number)

Customer	#text(#field(13427)) #text(#field(13428))
Property Address	#text(#field(13429)) #if(#field(13430))#text(#field(13430)) #endif#text(#field(13431)), #text(#field(13432)) #text(#field(13433))
Property Mailing Address	#if("#text(#field(13435))" == "Property mailing address is same as physical address")Property mailing address is same as physical address.#endif#if("#text(#field(13435))" != "Property mailing address is same as physical address")#text(#field(13436)) #if(#field(13437))#text(#field(13437)) #endif#text(#field(13438)), #text(#field(13439)) #text(#field(13440))#endif
Contractor / Owner	#text(#field(13442))
Subdivision / Lot	#text(#field(13443)) / #text(#field(13444))
Date of Treatment	#text(#field(13445))
Treatment Type	#text(#field(13446))
Structure Type	#text(#field(13447))

PRE-CONSTRUCTION OR PRE-TREAT PERIMETER FINAL GRADE OR WOOD TREATMENT TERMITE ONLY		EXISTING/POST CONSTRUCTION OR RETREAT/EXISTING CONTRACT OR SPOT TERMITE ONLY		DILUTE PESTICIDE APPLIED OR TERMITE BAIT INSTALLATION
Horizontal Barrier Treated (Sq. Ft.)	Vertical Barrier Treated (Linear Ft.)	Linear Ft. Treated @ 4 Gal per 10 Linear Ft.	Linear Ft. Treated @ 2 Gal per 10 Linear Ft.	Pesticide Brand Name OR Baiting System Brand Name	Percent Finished Solution	Total Gal Applied OR # of Bait Stations Installed
#text(#field(13451))	#text(#field(13454))	#text(#field(13452))	#text(#field(13455))	#text(#field(13453))	#text(#field(13456))	#text(#field(13457))

#section_rows_end

Submission ID: #submit_id