Monthly Report of Wood Destroying Insect Control Work

Mississippi Department of Agriculture & Commerce — Bureau of Plant Industry

Report Information

Company Name

#field(14183)

Licensee

#field(17319) #field(17320)

Contact

#if("#text(#field(17342))" == "Yes")Same as Licensee#endif#if("#text(#field(17342))" != "Yes")#field(17341) #field(17340)#endif

Phone

#field(17321)

#field(17322)

PHYSICAL ADDRESS

#text(#field(14184))#if(#field(14185))
#text(#field(14185))#endif
#text(#field(14186)), #text(#field(14187)) #text(#field(14188))

MAILING ADDRESS

#if("#text(#field(14190))" == "Mailing address is same as physical address")Mailing address is same as physical address.#endif#if("#text(#field(14190))" != "Mailing address is same as physical address")#text(#field(14191))
#if(#field(14192))#text(#field(14192))
#endif#text(#field(14193)), #text(#field(14194)) #text(#field(14195))#endif

Report Month / Year

#field(14197) #field(14198)

Work Performed This Month

#field(14200)

#if("#text(#field(14200))" == "Yes")

Termiticide Inventory

#section_rows_start(2359) #section_rows_end

Item	Brand Name	Formulation	Beginning	Used	Purchased	End
#section_row_number	#text(#field(14204))	#text(#field(14205))	#text(#field(14206))	#text(#field(14207))	#text(#field(14208))	#text(#field(14209))

Treatment Records

#section_rows_start(2362)

Treatment Record #section_row_number

Customer	#text(#field(14215)) #text(#field(14216))
Property Address	#text(#field(14217)) #if(#field(14218))#text(#field(14218)) #endif#text(#field(14219)), #text(#field(14220)) #text(#field(14221))
Property Mailing Address	#if("#text(#field(14223))" == "Property mailing address is same as physical address")Property mailing address is same as physical address.#endif#if("#text(#field(14223))" != "Property mailing address is same as physical address")#text(#field(14224)) #if(#field(14225))#text(#field(14225)) #endif#text(#field(14226)), #text(#field(14227)) #text(#field(14228))#endif
Contractor / Owner	#text(#field(14230))
Subdivision / Lot	#text(#field(14231)) / #text(#field(14232))
Date of Treatment	#text(#field(14233))
Treatment Type	#text(#field(14234))
Structure Type	#text(#field(14235))

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(14239))	#text(#field(14242))	#text(#field(14240))	#text(#field(14243))	#text(#field(14241))	#text(#field(14244))	#text(#field(14245))

#section_rows_end #endif

Submission ID: #submit_id