9 Cushing St #1 pest control 4-24-24 1-7�"] q ..3 pa CUSTOMER SERVICE
REPORT
SERVICE ADDRESS SERVICE PERIOD ACCOUNT NO.
1 SVSP#
SERVICE SPECIALIST iv>P
LICENSE NUMBER a g-7 ( y
SPECIAL INSTRUCTIONS .
0 1 f 7 SERVICE DATE '� U �� ��, �U 'L 4t
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Service Specialist must add any state required information to this form.
TARGET PET PESTICIDE USED DESCRIPTIONCODE AMOUNT METHOD SITES
L �— >•This confidential report is provided to identify sanitation deficiencies,structural defects and improper storage practices contributing to pest infestations.
'If pesticide is not listed on back,enter product name,EPA registration number on concentration used in space provided. res No
1. Any pest activity found during this montht service? O
cockroaches flies r da' ants other
2. Are there any structural problems that could cause pest problems? gwu Q— N O i-e S F[�v>✓ _1 1
G. Are there any sanitation problems that could cause pest problems?VkCA Sc, C(t ww U_VR 1411 t7 ( � r al>4"
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4. Are the ny i u regarding facility preparation or service �n
Note to Customer.After service,alf food writ surfaces mart be washed in order W rernwe arty possible chemical residue.
CONDITIONS FOUND/ACTIONS TAKEN
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IF REQUIRED,NOTE WEATHER CONDITIONS HERE.
SVSP Signatures. _�___ Start Time V End Time