CONSUMER INFORMATION NOTICE APPLICATOR OR BUSINESS NAME ADDRESS PHONE NUMBER

Transcription

1 CONSUMER INFORMATION NOTICE APPLICATOR OR BUSINESS NAME ADDRESS PHONE NUMBER Dear Customer: As of November 19, 2001, the New Jersey DEP Pesticide Control Program instituted a new program that requires us to provide customers with information about the pesticides we will be using as part of the pest control program for your property. This CONSUMER INFORMATION NOTICE provides you with this information. This CIN lists any label precautions for the pesticide(s) listed below that you should be aware of. You should also be aware that you may request notification of the exact date(s) of any pesticide application, and a copy of the label for each pesticide that will be used. BRAND NAME (CODE) COMMON NAME (CODE) INSTRUCTIONS AND PRECAUTIONS We are also required to provide the following phone numbers for your use in the event you have any health related questions concerning the materials that we will be using: New Jersey DEP Pesticide Control Program (This number is for pesticide regulations information, complaints & health referrals.) (609) As the customer, you are entitled by the New Jersey Pesticide Control Regulations to ask us for a copy of the label for each pesticide that will be used on your property, and if you request them, we are required to provide them to you. Furthermore, if this is a contract for termite control, we are required to give you, without your asking, a copy of N.J.A.C. 7: or a Department approved summary of N.J.A.C. 7: regarding proper application of termiticides. Sanitation, as well as physical and biological control measures, should be considered as another part of a good pest control program. Pesticides may be used as another part of a good pest control program. Pesticides are substances used to control living organisms and vary in degree of toxicity. As the customer, I acknowledge that has provided me, in writing, all the information required by the NJ DEP Pesticide Control Program's notification program. I have read the information supplied and understand my rights and responsibilities under this program. Signed: Date: PLEASE RETURN THE SIGNED PORTION OF THIS CONSUMER INFORMATION NOTICE TO US.

2 TURF/ORNAMENTAL CONSUMER INFORMATION NOTICE APPLICATOR OR BUSINESS NAME APPLICATOR OR BUSINESS ADDRESS PHONE NUMBER Dear Customer: As of November 19, 2001, the New Jersey DEP Pesticide Control Program instituted a new program that requires us to provide customers with information about the pesticides we will be using as part of the pest control program for your property. This CONSUMER INFORMATION NOTIFICATION provides you with this information. This CIN lists any label precautions for the pesticide(s) listed below that you should be aware of. You should also be aware that you may request notification of the exact date(s) of any pesticide application, and a copy of the label for each pesticide that will be used. BRAND/COMMON NAME(S) (See Back For Codes) PRECAUTIONS TO BE TAKEN If applications are made to ornamentals or turf, at least one sign will be placed on your property that says PESTICIDE TREATED AREA and contains the international signage for KEEP OFF THE GRASS. We are required to do this by regulation. The sign(s) must be in place at the start of the application and may be removed after 72 hours. To help keep the cost of this new program at a minimum, we are requesting that our customers be responsible for removing the sign(s) no sooner than 72 hours following each pesticide application. We would appreciate it if you would do so. We are also required to provide the following phone numbers for your use in the event you have any health related questions concerning the materials that we will be using: New Jersey DEP Pesticide Control Program (609) (This number is for pesticide regulations information, complaints & health referrals.) Sanitation, as well as physical and biological control measures, should be considered as another part of a good pest control program. Pesticides may be used as another part of a good pest control program. Pesticides are substances used to control living organisms and vary in degree of toxicity PLEASE SIGN AND RETURN THIS PORTION OF THE CONSUMER INFORMATION SHEET TO US FOR OUR RECORDS. As the customer, I hearby certify that has provided me, in writing, all the information required under the NJDEP Pesticide Control Program's notification program. I have read the information supplied and understand my rights and responsibilities under this program. I also agree to remove the notification sign(s), that the company posts on my property following a pesticide application to turf or ornamentals. The signs may be removed no sooner than 72 hours following each pesticide. Signed: Date:

3 Consumer Information Notice Commercial Building Posting Company name, address and telephone For additional information contact name at: phone # Sanitation, as well as physical and biological control measures, should be considered as part of a good pest control program. Pesticides may be used as another part of a good pest control program. Pesticides are substances used to control living organisms and vary in degree of toxicity. National Pesticide Information Center (General Questions) (800) New Jersey Poison Information & Education System (Emergencies) (800) New Jersey DEP Pesticide Control Program (609) (This number is for pesticide regulation information, complaints & health referrals.) Pesticides that may be used: Brand name Active Label instructions/precautions Ex 1 Termidor SC Fipronil DO NOT CONTACT TREATED AREAS UNTIL SPRAYS HAVE DRIED. Ex 2 Dimension Dithiopyr KEEP PEOPLE AND PETS OFF TREATED AREAS UNTIL DUST HAS SETTLED. Ex 3 Evercide Esfenvalerate REMOVE PETS, BIRDS, AND COVER FISH AQUARIUMS BEFORE SPRAYING = Chemical Code Year: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec O = Intended Date of Next Application X = Actual Application The exact dates of application shall be made available to the customer, if requested. A copy of the label(s) for the pesticide(s) used shall be available to the customer, if requested.

4 Consumer Information Notice Company name, address, and telephone number Sanitation, as well as physical and biological control measures, should be considered as a part of a good pest control program. Pesticides may be used as another part of a good pest control program. Pesticides are substances used to control living organisms and vary in degree of toxicity. New Jersey DEP Pesticide Control Program (609) (This number is for pesticide regulation information, complaints & health referrals.) Pesticides that may be used: * Brand name Active Label instructions/precautions Remove yourself and pets from the structure if you see any signs of leakage. Ex 1 Termidor SC Fipronil Residents and pets should not be in immediate area during application. Do not contact treated surfaces until sprays have dried. Cover or remove all food and food processing equipment during application. Ex 2 Evercide Esfenvalerate Remove pets, birds, and cover fish aquariums before spraying. Do not allow children or pets to contact treated surfaces until spray has dried. Do not enter treated area until sprays have dried. Ex 3 Drive 75 DF Quinclorac Do not use clippings as mulch or compost around flowers, ornamentals, trees or in vegetable gardens * = Chemical Code The exact dates of application shall be made available to the customer, if requested. A copy of the label(s) for the pesticide(s) used shall be available to the customer, if requested.

5 Commercial Building Posting Year: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec O = Intended Date of Next Application X = Actual Application Brand name Active Ingredient Brand name Active Ingredient For additional information contact name at: phone # I, the undersigned, understand that the New Jersey Department of Environmental Protection, Pesticide Control Program s Regulations require that the above information be posted pursuant to N.J.A.C 7: (d)3. I agree to allow this notice to be posted by the Applicator Business. The Department will allow removal of the notice after 60 days if no further treatments are projected. Signed: Date: