Pest Control Treatment Certificate - Rodent Station Report

• Site conducted

  Select

• Company Name

  Qube Energy

  Chevron

• Property Address

  42 Ulm Place, Hazelmere

  124 Quill Way, Henderson

  Other

• Date

  Date

• Time Started

  Date

• Time Completed

  Date

• Technician Name

  Allan Polkinghorne

  Mark Byleveld

  Other

• Job Number

Treatments and Areas Serviced

• Type of Treatment

  Select Container Treatment Residual Spray Rodents Snail Pellets Spiders Flying Insects Escargo Yard Equipment Fogging ULV Weeds Fumigation Other Crawling Insects

  • Container Treatment
  • Residual Spray
  • Rodents
  • Snail Pellets
  • Spiders
  • Flying Insects
  • Escargo
  • Yard Equipment
  • Fogging
  • ULV
  • Weeds
  • Fumigation
  • Other
  • Crawling Insects

• Area Treated

  Select Warehouse - Internal Warehouse - External Garden Fence Line Door 1 Door 2 Door 3 Door 4 Door 5 Door 6 Door7 Fence line Other

  • Warehouse - Internal
  • Warehouse - External
  • Garden Fence Line
  • Door 1
  • Door 2
  • Door 3
  • Door 4
  • Door 5
  • Door 6
  • Door7
  • Fence line
  • Other

Treatment And Release Information

Total Bait Stations

• Date & Time

  Date

• Bait Station #

• Chemical Used

  Select Ethyl Formate Suspend Flexx Pestigas Rodent Bait Suspend Flexx, Pestigas & Ditrac Profume Country Glyphosate 360 Biflex Aquamax Insecticide Ditrac Talon Garrards Pyrethrin Drift Aqua K Mortein Bomb Flour Tray Insect sticky trap N/A

  • Ethyl Formate
  • Suspend Flexx
  • Pestigas
  • Rodent Bait
  • Suspend Flexx, Pestigas & Ditrac
  • Profume
  • Country Glyphosate 360
  • Biflex Aquamax Insecticide
  • Ditrac
  • Talon
  • Garrards Pyrethrin Drift
  • Aqua K
  • Mortein Bomb
  • Flour Tray
  • Insect sticky trap
  • N/A

• Active Ingredient

  Select Deltamethrin 0.025% Brodifacoum 0.05% Glyphosate Sulfuryl Fluoride Pyrethrum Bifenthrin 10% Ethanol and formic acid N/A

  • Deltamethrin 0.025%
  • Brodifacoum 0.05%
  • Glyphosate
  • Sulfuryl Fluoride
  • Pyrethrum
  • Bifenthrin 10%
  • Ethanol and formic acid
  • N/A

• Amount of Baits Placed

  1

  2

  3

  4

  N/A

• Photo of Bait Station (Before)

  Media

• Photo of Bait Station (After)

  Media

• Additional Comments

Pest Technician Release

Technician Release Signoff

• Date

  Date

• Pest Technician

  Select Allan Polkinghorne Mark Byleveld Other

  • Allan Polkinghorne
  • Mark Byleveld
  • Other

• Pest Technician

• Qube Energy

• License Number

• Allan Polkinghorne

  Sign

• Pest Technician

• Qube Energy

• License Number

• Add signature

  Sign

• Pest Technician

• Qube Energy

• License Number

• Mark Byleveld

  Sign