Termite Pretreatment Notification

Notification of Intent to Conduct Preconstruction Treatments

PEST CONTROL COMPANY INFORMATION

*Company Name:

 

 

*Date form submitted:

Contact

 

Company Number:

E-Mail Address:

 

*Phone/Extension:

 

DETAILED INFORMATION

Per NAC 555.427 a complete "Termite Pretreatment Notification Form" must be submitted to the Nevada Department of Agriculture before performing a preconstruction treatment.

Indicate Application Details Below:

 
Site (subdivision) Name:

*Location or address (including zip code)

Address:

City:   State:  

Zip:  

Major Cross Streets:

 

*Builder / Contractor

*Expected starting Date:

    *Expected Completion Date:

*Number of sites that will be treated:

 

*Treatment Type:

 
          

 

Location where NDOA "Pre-treatment Tag" (green) will be placed.

 
          
 
 

Other Placement:

 

 

Fields marked with * are required.