OFN 1177 S Wellesley Ave
Address: , Los Angeles, CA 90049 ☐ Single Family Dwelling ☒ Multi Family Dwelling ☐ Other _________________________________________ Full Name: Telephone Number: Emergency Contact Full Name: Prime Contractor ACCURATE TERMITE AND PEST CONTROL Fumigation Contractor: NEXT GENERATION FUMIGATION Emergency Number: 818-515-2387Target Pest(s): ☒ Drywood Termites ☐ Beetles ☐ Other(s)N/AFumigants proposed to be used: ☐ Methyl Bromide ☒ Sulfuryl Fluoride: Vikane (Product Name)
Initials: Dates of Fumigation: March 28th through March 30th
This building will be fumigated with lethal gas 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 after 12PM on the last day of fumigation, AND the fumigation company’s notice is posted, giving the time and date safe for re-entry. Initials 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? NoYes “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 (see below) 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: Accurate Termite and Pest Control 888 584 7187; for Health Questions – the County Health Department (see below); for Application Information – the County Agricultural Commissioner (SEE BELOW) and for Regulatory Information contact the Structural Pest Control Board, 800) 737-8188, 2005 Evergreen Street, Suite 1500, Sacramento, CA 95815-3831.
For Health Questions
We suggest that you notify neighbors of the date of the fumigation and 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 and procedures for leaving the structure
Date: June 8, 2023
Read carefully- state law requires your signature. it is the responsibility of the owner, or owners agent, to have all items on this checklist done before the crew arrives; failure may postpone the fumigation
TEL 818-515-2387FUMIGATION DISCLAIMER
Chemical: Vikane The crew’s estimated time of arrival is approximate only. Allow a minimum variance of two hours as traffic, wind, rain, etc., may delay our arrival. Due to unforeseen problems or safety reasons, we may require that the structure be vacated for an additional 24 hours. Wind and rain may necessitate the postponement of your job. We can not endanger our employees or your structure in adverse weather conditions. Please note that we do not work on Sundays or Holidays. If your fumigation falls within a weekend or holiday, please make sure to allow for the extra day(s) that you will be out of the structure.
On the first day the structure is covered and the fumigant introduced. During this time a minimum of one operable window per room will be open at least 3 inches. On the next workday the aeration process begins. The final step is certification for re-entry which should occur by 6 PM. For a Vikane fumigation this is the day the tarp is removed, and it will be posted on the doors that it is safe for re-entry. We WILL make every effort to have you back into your structure by 6 PM, barring UNFORESEEN circumstances.
Under no circumstances may anyone enter the structure until it has been declared safe for re-entry by a licensed fumigator. Anyone entering the structure prior to the re-entry time is violating the California Structural Pest Control Act. This is punishable by a fine of one thousand dollars, six months in jail, or both.Although the fumigant has been AERATED from the structure, the warning agent may remain. If this occurs, open all windows for two or more hours. Running the heater may also help. damp conditions may cause the warning agent to linger.
If 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 and notify your termite company. The warning agent, Chloropicrin, can cause symptoms of tearing eyes, respiratory distress and vomiting. Entry into the structure during the FUMIGATION CAN BE FATAL.
Structural fumigants are colorless, odorless and do not affect paints, or finishes. Dishes and utensils can be used without washing, as the chemical does not leave a residue.It is the responsibility of the homeowner; occupant or homeowners agent to have all of the items on this checklist done before the crew arrives. Failure to do so may postpone the fumigation. Any problems resulting from non-compliance to this checklist by the homeowner, occupant or homeowners agent will not be the liability of the accurate termite and pest control or Next Generation Fumigation to resolve or correct. Any delays caused by any units’ failure to prepare may result in a delay fee of no less than $350.00 plus any secondary costs including legal fees, locksmith fees, loss of time and damages incurred by Accurate Termite and Pest Control, Management, and affected units will be imposed on the unprepared unit.
Unit Access Information:
We hope that your fumigation will be problem free, however there are at times unavoidable problems. We are providing the following information so that you may be made aware of possible unavoidable circumstances.
THIS NOTICE HAS BEEN PRINTED IN THE ENGLISH LANGUAGE. BY SIGNATURE HERE ON,THE HOMEOWNER, AGENT OR OCCUPANT (S) AGREE (S) THAT HE/SHE HAS HAD THESE FORMS EXPLAINED TO THEM IN THEIR NATIVE TONGUE BY THEIR OWN INTERPRETER. AFTER READING THIS NOTICE PLEASE PRINT YOUR NAME BELOW AND THEN SIGN ON THE AUTHORIZED LINE BELOW.
By signing my name above, I am stating that I have read all statements and conditions explained in the Occupants Fumigation Notice as well as this disclaimer. I have received a copy of the Vikane/master fume Fact Sheet.
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: OFN 1177 S Wellesley Ave
Agree & Sign