Louisiana Departmetn of Agruculture & Forestry

LOUISIANA DEPARTMENT OF AGRICULTURE & FORESTRY MIKE STRAIN DVM, COMMISSIONER Agricultural & Environmental Sciences, 5825 Florida Blvd., Suite 3003, Baton Rouge, LA 70806, (225) 925-4578, FAX (225) 923-4878 *2325* TERMITE PERIMETER APPLICATION

PLEASE TYPE NAME AND ADDRESS OF PEST CONTROL CO: PLACE OF BUSINESS PERMIT NO: REPORT FOR THE MONTH OF:

CONST. NAME/ADDRESS OF LOCATION/ADDRESS OF DATE INITIAL DATE PERIMETER TYPE PROPERTY OWNER PROPERTY TREATED TREATMENT BEGAN CONCLUDED

LICENSEE/LICENSEE NUMBER: DATE

CONSTRUCTION TYPES: A) SLAB B) SLAB/PIER C) PIER D) OTHER

LAC 7:14135.(T)2. WITHIN TWELVE MONTHS AFTER INITIAL TREATMENT OF THE OUTSIDE OF THE FOUNDATION, THE PERIMETER WILL BE TRENCHED AND TREATED AS REQUIRED BY LABEL AND LABELING. THE LICENSEE SHALL REPORT THE COMPLETION OF THE APPLICATION TO THE OUTSIDE OF THE FOUNDATION TO THE LOUISIANA DEPARTMENT OF AGRICULTURE AND FORESTRY ON THE TERMITE PERIMETER APPLICATION FORM. RODDING SHALL BE ACCEPTABLE ONLY WHEN TRENCHING WILL DAMAGE IRRIGATION EQUIPMENT, UTILITY EQUIPMENT, FLOWERS AND/OR SHRUBS LAC 7:14113: THE LICENSEE MUST REPORT TO THE LOUISIANA DEPARTMENT OF AGRICULTURE AND FORESTRY ALL TERMITE CONTRACTS, TERMITE PERIMETER APPLICATIONS AND WOOD DESTROYING INSECT REPORTS COMPLETED EACH MONTH ON A FORM PROVIDED BY THE LOUISIANA DEPARTMENT OF AGRICULTURE AND FORESTRY. THE REPORTS LISTED ABOVE ARE DUE IN THE DIVISION OF PESTICIDES AND ENVIRONMENTAL PROGRAMS OFFICE IN BATON ROUGE ON OR BEFORE THE TENTH OF THE MONTH FOLLOWING THE CONTRACT OR APPLICATION.

Please Return this Form & Remittance to: Louisiana Department of Agriculture & Forestry 5825 Florida Blvd., Suite 1003 Baton Rouge LA 70806

AES-23-25 (r.2/16)

WOOD DESTROYING INSECT ERADICATION REPORT 0600 1595 01