1236 NE 99 St (5)1 T E FUMIGATION
PROFESSIONAL DUALITY FUMIGATION AND TERMITE WORK
7471 N.W. 8 STREET, MIAMI, FL. 33126 / P.O. BOX 441687, MIAMI, FL. 331441687 / TEL. 282 -3301
TERMITE & FUMIGATION, DIV., INC.
7471 N.W. 8 STREET
MIAMI, FL 33126
262- 3301 -- -DADE
(FUMIGATOR - WHOLESALER)
LOCATION OF STRUCTURE:
OWNER'S NAME & ADDRESS:
TYPE OF STRUCTURE :CBS
APPROXIMATE CUBIC FEET:
cc: County Health Department:
Fire Department:
FUMIGATION NOTIFICATION
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OTHER
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NAME & APPROXIMATE QUANTITY OF FUMIGANT:VIKANE
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J71(o/e-iu'
(CONTRACTOR - RETAILER)
RESIDENCE APTS OTHER
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OTHER
DATE & APPROXIMATE TIME OF RELEASE OF FUMIGANT:
APPROXIMATE LENGTH OF FUMIGATION PERIOD:
CERTIFIED OPERATOR IN CHARGE: BOB LOZANO
TELEPHONES: 262 -3301 (day) DADE COUNTY
264 -5754 (night) DADE COUNTY
Fumigation shall be performed at all times in strict adherence to
the Fumigant's registered label and Florida State Division of Health
Regulations, Chapter 1701 -2 of the Florida Administrative Code.
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SEAL FUMIGATION: TENT FUMIGATION:
lbs
TERMITE & FUMIGATION, DIV., INC. shall hold itself primarily
liable to the Florida State Department of Health and Rehabilitative
Services for the full performance of all fumigation work performed
on the above described premises, and shall hold itself primarily
liable for the full performance of all of the terms and conditions
of the retail Florida Statutes and Chapter 10D -55, Florida Admini-
strative Code.
9 o r
APPLICATION
Fumigate X
FOR PERMIT TO FUMIGATE WITH CYANIDE METHYL BROMIDE ACRITET
APPLICATION NO. DATE / 19 7
1. Location of building to be fumigated 1296 N. E.' 99 Street , Miami Shores
2. Name and address of owner of premises W.H. Warthman
3. Type, size and construction of building CBS — Fain. Residence
4. Is entire building to be fumigoieu .YOE
5. If not, state what portion
6. Approximate number of cubic feet of space in building or in portion to be fumigated.
11 ,.752
7. Kind and quantity of fumigant to be used and manner of application and length of fumigation period
Fumigate - Approx 24 hours
8. Distance of nearest building and direction from building to be fumigated
9. In what manner will vents to exterior of building be sealed?
10. Date whem fumigation will be begun
over 12 feet
•
(Signature % certified p
of this f igation job.
Ny) an tent
st 1' 1967 Time 12 :00
11. It is hereby agreed to station a guard on the premises to be fumigated during the fumigation period and to post
suitable placards at each entrance into the building bearing the following words in letters at least two inches
by one inch in size: "DANGER" — THIS BUILDING UNDER FUMIGATION WITH A DEADLY GAS.
12. It is hereby agreed to make such provisions that all openings into the building may be opened from the.outside
after the period of fumigation is over and to take such other precautions as may be necessary to insure that all
of the fumigant is removed from the building before anyone is permitted to enter.
13. It is hereby agreed to notify the County Health Department when the building has been prepared for fumigation.
FIRM NAME: TRULY NOLEN, INC.
600 N. W. 7th Avenue
Miami 36, Florida
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