Rev Date 3-20-18
Name of Business/ Individual
Address of Business or
Business License Number
Vehicle Information (If applicable)
Make, Model , Color
Statement of Event/ Observation
Please be specific. (Attach additional pages, photographs or documentation as needed).
*Note: Please be advised this Agency has no statutory authority
regarding efficacy, price, or contractual matters. Also note pesticide
registration is approved on a Federal level by the Environmental
Protection Agency, and as such this Agency has no statutory authority
to prohibit lawful applications of any registered pesticide.
Oftentimes, a complaint can be resolved before we begin our
investigation. Have you attempted to contact the company to resolve