205 HIGHLAND AVENUE PEST CONTROL REPORT 3-13-2025ORDER #:
WORK DATE:
2216388
03/13/2025
A-1 Exterminators
P.O. Box 310
Lynn, MA 01903-0310
781-592-2731
AL-0041678License #:
Geoffrey Ouellette
Time In:
Time Out:
03/13/2025 10:04:25 AM
03/13/2025 10:07:31 AM
Technician Signature
Customer Signature
Customer is unavailable to sign
175082LOCATION
978-825-0030
HAWTHORNE COMMONS-MAIN ACCT
205 HIGHLAND AVENUE
SALEM, MA 01970
Phone:
175082BILL-TO
978-825-0030
HAWTHORNE COMMONS
205 HIGHLAND AVENUE
SALEM, MA 01970
Phone:
Purchase Order AmountService Description QuantityTerms
NET 30None 160.002.00Roach Control Apartment 2307 AND 4206
Total Due:160.00
0.00Tax
160.00Subtotal
GENERAL COMMENTS / INSTRUCTIONS
ROACHES 2 APTS 2307 AND 4206 CALLED IN BY GEOFF $80 PER UNIT
2307 = vacant unit. Removed dead roach in bath tube. Treated unit for roaches.
4206 = tenants had seen a roach but found no evidence of roaches. Treated unit for roaches.
ReviewedResponsibilitySeverityCONDITIONS / OBSERVATIONS Reported
None Noted.
PRODUCTS APPLICATION SUMMARY
Finished QtyA.I. Conc.Undiluted QtyEPA #A.I. %Active IngredientMaterialLot #
n/aSureKill Roach Gel 2.1500%2.0000 Grams92028-3-47000 lmidacloprid
Target Pests:Roaches
Pest TotalsPEST ACTIVITY # Areas # Devices
None Noted.
DEVICE INSPECTION SUMMARY
AREA COMMENTS
None Noted.
OCCUPIED AREAS MUST BE VACATED FOR _______ HOURS. THOROUGHLY VENTILATE TREATED AREAS BEFORE THEY ARE REOCCUPIED. DO NOT
ALLOW ADULTS, CHILDREN, OR PETS ON TREATED SURFACES UNTIL DRY.
CONTRACTING ENTITIES HAVE RECEIVED ALL MASSACHUSETTS DEPARTMENT OF FOOD & AGRICULTURE'S PESTICIDE BUREAU CONSUMER
SHEETS, WRITTEN STATEMENTS, POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANTS 2-7 DAYS PRIOR TO APPLICATION TIME. THE
ABOVE SERVICE HAS BEEN SATISFACTORILY COMPLETED.
INS 5-1
Printed: 03/13/2025 Page:1/2
ORDER #:
WORK DATE:
2216388
03/13/2025
A-1 Exterminators
P.O. Box 310
Lynn, MA 01903-0310
781-592-2731
DEVICE INSPECTION EXCEPTIONS
None Noted.
INSPECTION DETAIL
None Noted.
PRODUCTS APPLIED
TimeFinished QtyA.I. %Application Equipment
Application Method
Material
Sq/Cu/L FtA.I. Concentration Undiluted Qty Lot #EPA #
Crack & Crevice
2.0000 GramsSureKill Roach Gel 2.1500%
92028-3-47000 n/a
10:04:40 AM
Target Pests:Roaches
0˚, 0 MPHWeather:
OCCUPIED AREAS MUST BE VACATED FOR _______ HOURS. THOROUGHLY VENTILATE TREATED AREAS BEFORE THEY ARE REOCCUPIED. DO NOT
ALLOW ADULTS, CHILDREN, OR PETS ON TREATED SURFACES UNTIL DRY.
CONTRACTING ENTITIES HAVE RECEIVED ALL MASSACHUSETTS DEPARTMENT OF FOOD & AGRICULTURE'S PESTICIDE BUREAU CONSUMER
SHEETS, WRITTEN STATEMENTS, POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANTS 2-7 DAYS PRIOR TO APPLICATION TIME. THE
ABOVE SERVICE HAS BEEN SATISFACTORILY COMPLETED.
INS 5-1
Printed: 03/13/2025 Page:2/2