Nevada Department of Agriculture
Soil Pre-Treatment Electronic Tag for Final Grade Treatments

Electronic Tag

This form can only be used if the
green final grade
cannot be placed in an external electrical  box.


*Pest Control Company Name:

*Date of Application:

*Builder's Name:

*Subdivision Name:  
  (i.e. Willow Springs @ Sloan)
*Property Address / Location
*City:  State: Nevada
*Zip Code:  
  (i.e. 89142 or 89142-0000)
*Chemical Used:  
  (i.e. Demon TC)
*Use Dilution (% Applied):  
  (i.e. 0.25)
*Gallons Applied:  
  (i.e. 165)
*Full Name of Applicator:

Additional Information
(choose only one):


If you have selected "other" above please explain:

For Agriculture use only:

* = required information