OCCUPANTS FUMIGATION NOTICE & PESTICIDE DISCLOSURE IDEAL FUMIGATION, INC. (310) PR# 3438

Transcription

1 OCCUPANTS FUMIGATION NOTICE & PESTICIDE DISCLOSURE IDEAL FUMIGATION, INC. (310) PR# 3438 JOB ADDRESS: Click here to enter text. Single Family Dwelling Multi Family Dwelling Other Owner/Agent: Click here to enter text. Tel. No: Click here to enter text. Occupant: Tel. No: Emergency No: Emergency No: Fumigation Contractor: Ideal Fumigation, Inc. Emergency No. (310) Prime Contractor: Solo Termite & Pest Control Emergency No Target Pest(s): Drywood Termites Beetles Other (s) Fumigants proposed to be used: Methyl Bromide Sulfuryl Fluoride: Vikane Other (s) Are you aware of any conduits, pipes, common drains, air ducts, central vacuum systems, or any other construction elements that would allow the passage of a fumigant from the structure to be fumigated to any other adjacent or adjoining structure(s)? YES NO CHLOROPICRIN WILL BE USED AS WARNING AGENT WITH EITHER FUMIGANT Dates of fumigation: Click here to enter text. Date changes/alternative date: Initials: IMPORTANT - READ CAREFULLY THIS BUILDING WILL BE FUMIGATED WITH LETHAL GASES ON THE DATE(S) INDICATED ABOVE. ALL PERSONS AND ANIMALS MUST VACATE THE PREMISES ON OR BEFORE ARRIVAL OF THE FUMIGATION CREW. UNDER NO CIRCUMSTANCES CAN ANYONE ENTER THE BUILDING UNTIL THE FUMIGATION COMPANY'S NOTICE IS POSTED GIVING THE TIME AND DATE FOR SAFE RE-ENTRY. "State law requires that you be given the following information: CAUTION-PESTICIDES ARE TOXIC CHEMICALS. Structural pest control companies are registered and regulated by the Structural Pest Control Board, and apply pesticides which are registered and approved for use by the California Department of Pesticide Regulation 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 you experience symptoms of dizziness, headache, nausea, reduced awareness, slowed movement, garbled speech or difficulty in breathing, leave the structure immediately and seek medical attention by contacting your physician or Poison Control Center (telephone number) and notify your pest control company. The warning agent, CHLOROPICRIN, can cause symptoms of tearing, respiratory distress and vomiting. Entry into the space during fumigation can be fatal. For further information, contact any of the following: Your pest control company (telephone number); for health questions - the County Health Department (telephone number); for Application Information - the County Agricultural Commissioner (telephone number) and for Regulatory Information - the Structural Pest Control Board, 800/ , 2005 Evergreen St., Suite 1500, Sacramento, CA

2 FOR HEALTH QUESTIONS: COUNTY HEALTH COUNTY DEPARTMENT AGRICULTURAL COMMISSIONER POISON CONTROL CENTER STRUCTURAL PEST CONTROL BOARD Los Angeles (213) San Bemadino (909) Riverside (951) Orange (714) Ventura (805) Los Angeles (626) San Bemadino (909) Riverside (951) Orange (714) Ventura (805) PHONE # (800) (415) PHONE # (800) (916) (This section may be modified to include the information of the geographical area served by the licensee.) We suggest that you notify nearby neighbors of the date of fumigation and to keep pets away during the fumigation. Close off any open access to the subarea to prevent pets from entering. I hereby acknowledge receipt of a copy of this document as well as a list that includes the instructions for the necessary preparations for the fumigation, procedures for leaving the structure, and the following documents. - Owner/Agent (signature): Occupants (signature):

3 TERMS, CONDITIONS, AND LIABILITIES - Ideal Fumigation (310) A. Our crews must fumigate several structures in various locations each day. Therefore, any time of day for the fumigation to be scheduled will be an approximate time only. Your fumigation may be cancelled on the same day, if weather conditions, do not permit a safe and effective service. There may also be postponements, If the said property, has not been prepared properly E.G. bagging or removal of food, clearing of obstructions at exterior, or if all signed permission forms are not at the job site. It is to the discretion of the management, to decide if any additional charges will be applicable in the case of negligence, on a case-by-case situation. B. We do not wish to inconvenience you by having you wait for our arrival on the day of the fumigation. Once you have chosen a day to fumigate, please decide in advance, where you wish to leave your keys. Contact your representative, and give them instructions on gaining entry to the property and how to lock up when our crews are completed. We request that you leave an emergency phone number in case of an emergency. C. Climbing plants, fences, trellises, vines, shrubs, bushes and trees, can be damaged during the process of fumigation. Our crews will take care to avoid any said damages, unfortunately, we cannot guarantee their safety and are not held liable for replacement or repairs. Care will be taken to avoid unnecessary damage. D. Fumigations require the use of masking tape. Where the painted surface is old, oxidized, or improperly applied, peeling or chipping will occur. Even though these surfaces appear to be in good condition we assume no responsibility for any damage. E. The roof surface and perimeter areas of the building must be walked upon, and damages occur, although the utmost care will be exercised Neither IDEAL FUMIGATION nor its licensed fumigator will assume any liability for such damage or consequential damage that may occur to roofs or roof coverings and areas below roofs. Also included are gutters, electrical wiring, patio and awning covers, solar heating panels, plumbing and living plants or landscaping at/adjacent to the subject property. F. We do not provide on-site security during the fumigation procedure or after the tent(s) or seals are removed. Our insurance does not cover malicious vandalism or theft. If you request a key to be left on the job site, IDEAL FUMIGATION assumes no responsibility for theft or break in, after the fact. G. IDEAL FUMIGATION assumes no responsibility for damages resulting to or from structures not built to construction codes. H. Old gas and water pipes may be damaged during the fumigation. IDEAL FUMIGATION is not responsible for damages. Gas and water pipes in good condition will not be damaged. IDEAL FUMIGATION assumes no liability for damage resulting from faulty gas meters. We are not responsible for damage to old or faulty furnaces and water heaters resulting from re-lighting procedures. If our crews are unable to relight your gas pilots, after the fumigation, you may be required and advised to call The Gas Company to relight your pilots. IDEAL FUMIGATION has no control of charges that the Gas Co. may charge for said services, and it will be the responsibility of the property owner to pay any fees if applicable. I. Your structure will be fumigated for the control of drywood termites or Click here to enter text. The fumigant proposed to be used is Sulfuryl Floride (Vikane) with Chloropicrin as the warning agent. State law requires that you begiven the following information: CAUTION-PESTICIDES ARE TOXIC CHEMICALS. Structural Pest Control 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 Food and Agriculture 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 headache, dizziness, nausea, tearing, coughing, nose and throat irritation or develop shortness of breath, double vision, unusual drowsiness and weakness, or tremors contact your physician or poison control center and your pest control operator immediately. J. "Notice to owner" Under the California Mechanics Lien Law any structural pest control company which contracts to do work for you and contractor, subcontractor, laborer, supplier or other person who helps improve your property, but is not paid for his or her work or supplies, has a right to enforce a claim against your property. This means that after a court hearing, your property could be sold by a court officer and the proceeds of the sale used to satisfy the indebtedness. This can happen even if you have paid your structural pest control company in full if the subcontractor, laborers or suppliers remain unpaid.

4 To preserve their right to file a claim or lien against your property, certain claimants such as subcontractors or material suppliers are required to provide you with a document entitled "Preliminary Notice." Prime contractors and laborers for wages do not have to provide this notice. A Preliminary Notice is not a lien against your property. Its purpose is to notify you of persons who may have a right to file a lien against your property if they are not paid. K. IDEAL FUMIGATION assumes no responsibility for the cost of lodging, meals, or other general expenses, if this property requires re-fumigation, under the warranty agreement. Certain food items require bagging and or removal from the property site, prior to the crew arriving on the day of your fumigation. Your representative can inform you of the specific preliminary preparations or you may also wish to call the office during normal business hours, to seek any additional information you may need. If IDEAL FUMIGATION needs to bag your food for you, there will be a charge of $50.00 per bag, this includes refrigerator and freezer items. The crew may decide to discard any items not bagged properly. IDEAL FUMIGATION will not be responsible for compensation of any items discarded, so please contact our office, if you have any questions. L. All exterior doors (including water heater cabinets) to the building being fumigated must be lockable. If no hasp or other interior/exterior locking devices exists, state law requires nailing these doors shut. If the homeowner of his/her agent has not provided adequate locks, and nailing is performed by the fumigation licensee, we will assume no liability for damage to the door or door jamb. Nailing or locking is required to keep out any person such as a small child, from being accidentally trapped inside. All doors must be unlocked and accessible for the fumigator to inspect the contents within, prior to fumigation. This includes, storage sheds, closets, bedrooms, etc. M. If tarping of the building will require entrance into your neighbor's yard by the fumigators, his pets must be removed or tied up. It is your responsibility to inform your neighbor and secure permission to enter their property. Your neighbor's plants may be affected if growing on/or directly adjacent to your building. IDEAL FUMIGATION will not be held liable for damages to your neighbors plants, during the process of fumigation, especially where they are adjoining or abutting your property. I/we the undersigned have read, reviewed, and agree to all the provisions contained herein and to items listed on the reverse side hereof that would be pertinent to me/us: Signature: Neighbors Signature(s): Tenant occupant(s) signature to be signed below and/or on attached sheet, if applicable. I/we have read, reviewed, and agree to all the provisions contained herein and to items listed on the reverse side hereof. Tenant Signature(s):

5 Ideal Fumigation Phone:(310) Fax:(310) ROOF RELEASE I (We), the undersigned Owner(s) (Agent) of the undersigned property, release Ideal Fumigation and/or Termite Company, Solo Termite Control Inc. from any and all responsibility for any damage done to roof covering as a result of tenting my (our) property for the purpose of fumigation. It has been explained to me (us) that every effort will be taken to reduce/avoid damage, but that damage may occur as it is necessary for workmen to walk upon my (our) roof. By my (our) signature below, I (we) release Ideal Fumigation and/or the termite company above mentioned from any and and all responsibility for damage to the root Tvpe of Roof Click here to enter text. Plant Release I (we) the undersigned owner(s) (agent) of the undersigned property will not hold Ideal Fumigation and/or the Termite Company, Solo Termite Control Inc. from any and all responsibility for any damage done to plant life in and around the property during the fumigation process. Property Address: Click here to enter text. Click here to enter text. Signature: