260 (Leeds Village) #2C Complaint 2015 •
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Geo Tracking #>Pp/5-CCQ58 Entered By: ✓J es C. , Date Entered: (4/1/.5
FOOD WATER/SEWER_ HOUSING 7 - SEPTIC HOARDING
PESTS NUISANCE ODOR_ SMOKE POOLS NAIL SALONS
BODYART OTHER
Inspection Scheduled on:
COMPLAINT INFORMATION:
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Complaint Location: Animals: Y/N Child Under 6: YIN
Date of Complaint: / / '/ )S
Nature of Complaint:
OMJ\ kkvf 1 o Mol(vJJ -,A to-a , t3 b23 or)20 - ermraitm
lahout b/ t 82. ant A f"ho/1 Ci r1CULimlom
COMPLAINTANT'S INFORMATION: RCA'
Complainant/Occupant's Name: 0-A ngr9, Telephone#
Mailing Address: j (0 U / N jT Alternate#
OWNER'S INFORMATION:
C 1
._.Owner's Name: ajit. r Address:
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Complaint Unfounded:
Conditions Found:
Property Mgr./LL
Address:
( )
a)",-!ei
Telephone# ( y -Jam
Alternate# ( ) -
- sty e.:s /51.6 --F7 lhAxr), rn.),
ACTION
TAKEN:
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Clan- `1v3 4"`r wn-k / /
Signature of Inspecting Officer 9 c x� ] Date/Time of Inspection
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D. 0. A. EXTERMINATING
Springfield, Massachusetts
(413) 330-7499
b Ticket
H
PON
Serviee
Amount
ga
C.O.D.
TIME
DAY
1VV
DATE
5 c2b 15
NEXT SERVICE
...
..:. :
LLA
_
E1H( OD
NE: IfUS NAME: /�
DRESS: /1 ST ADDRESS' 0
to .PtVN
Y: U • S+ATE: '4
P: CITY: 556TYYAAATE: ZIP:
)NE- /_ 4 a c C PHONE:
.
YPE OFSERWCt ( ) INITIAL ( REGULAR ( ) ONETIME ( ) FOLLOW-UP ( ) COMPLAINT
RVICEFOI(: ( ) ROACHES ( ) M
S ( cpRPEHTER ANTS ( ) ANTS ( ) FLEAS
WV
I HORNETSNVASPS ( OTHER: I. eolA
EAf APPUEDTOI: ( ) KITCHEN EQUIPMENT iic�- ' INTERIOR PERIMETER ( ) PIPES Se.)-FURNITURE
( )CUPVOARDS ( )EXTERIOR PERIMETER ( ) THER:
(WALL VOIDS ( 1d'CRACKSCREVICES
MODS OFAPPUCATTOM ( ORACKCCREVICE ( ) SPOT SPRAY OID TREATMENT ( )BAITING
()OTHER:
POWER SPY ( )GLUE TRAPS ( )SNAP TRAP
I FOGGING ( )
I CT ABUTTER NOTIFIED ( ) CT NOTIFICATION REG.INFO GIVEN ( ) CT EXTERIOR POSTED
I MASS CONSUMER INFO GIVEN ( )LABELS GIVEN ( )MASS POSTING
:HEMICAL
EPA II
%A1
QUANTITY
CHEMICAL
EPA I
%AI
QUANTITY
A-CHEM
53851-20205
99.0
6 Y12
6
MAKI BLOCKS
7173-20
.005
BORIC
9444429
90.0
Maki Meal
7173-108
005
C8-38
9444-21
2.7
Maki Pads
7173-171
.005
'3ONTRAC
12455-75
005
MAXFORCE
FC
84248.11
2.00
DEMON
10182-71
MAXFORCE
FCOEL
64240-14
2.15
DRIONE
481815324
51.0
3 fl7
PRECOR 1 %
2724-352-50809
0078
FILM 0
45839.3
1.0
PT 270
499-147
5
MAN PLUS
4583924
RO7OL BLUE
7173-172
20
GENTROL
2724351
50800
.0708
SAGA WP
432-755
.40
C538
9444-21
2.7ss
TEMPO 20 WP
3125-380
Kicker
4110.707M
ULD BP-100
11540-TX-1
5.94
ILLMASTER
2
28803-2
2.0
2P TRACKING
POWDFR
12455-1824
10.0
TIME IN: TIME OUT.
Received payment as follows:
( )CASH
WS-TOTAL:
[ 1-13(4-lei NI
( )CHECK
aK
- K'1 j^ 0✓IC (
'AID:
'AID:
� 3 0� vb 1 ON CCOUNT
I/ LI S ( d
_{�✓%l�F �iC ). O /V Fj- -
TECHNICIAN'S SIGNATURE: LICENSE 0: � 3•7e
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the undersigned,authorized and agree the work listed has bean ped es n and that I have received state
ndated materials as checked.I further agree to pay all collection costs,including reasonable attorney's fees and for
Mallon agency fees together with late charges on any unpaid balance beyond 15 days at a rate o11'h%per month.
�STOMER SIGNATURE: DATE:
DUE:
fb Ticket
B
* Nb Vs Sr
POq
I
E- S2(rvi 01 Lt -15UGS
D. 0. A. EXTERMINATING
Springfield, Massachusetts
(413) 330-7499
Service
Amount
/J
C.O.D.
TIME ) DAY
Vs
DATE
5d if-45
NEXT SERVICE
NE: MI si f: '�ll� - STATE: 2P:'
)NE:
NAME:
ADDRESS:
CRY: TATE:__ZIP:
PHONE:
'N�t .Hgt01:.
PE OFSERVIO4( ) INITIAL EGULAR ( ) ONETIME ( ) FOLLOW-UP ( ) COMPLAINT
VICEFORt ( ) ROACHES I ) I' EiR,qAfTS ) CARPENTER ANTS
HORNETSrWASPS ( .4 tTHER: I rci - (�(�GS
) ANTS ( ) FLEAS
' APPUEDT ( KITCHEN EQUIPMENT (jjrIINNTERIOR PERIMETER ( ) PIPES ( FURNITURE
NALL VOIDS CRACKS/CREVICES ( )CUPBaARDS ( )EXTERIOR PERIMETER ( ) OTHER:
HODS OF APPLICA17OP4 (�} WCREVICE ( ) SPOT SPRAY VOID TREATMENT
`OGGING ( ) POWER SPr7AY ( )GLUE TRAPS ( )SNAP TRAPP)OTHER: I 7 BAITING
�T ABUTTER NOTIFIED ( ) CT NOTIFICATION REG INFO GIVEN ( ) CT EXTERIOR POSTED
MSS CONSUMER INFO GIVEN ( )LABELS GIVEN ( )MASS POSTING
EM/CAL
CHEM
ORID
3-38
IITRAC
AEON
5
IONE
AM D
M PLUS
ITROL
B38
ekes
!ASTER
2
EPA %Al
53851-20205
99.0
9444-129
9t0
9444.21
2.7
QUANTITY CHEMICAL
/ e 2 11 MAKI BLOCKS
II Mald Meal
EPA I
7173-20
%Al
.005
QUANTITY
7171188
.005
12455-75
10182.71
.005
Meld Packs
MAXFORCE
FC
7171171
84248-11
.005
2.00
4818.5244
45839.3
51.0
45839-88
2724351
50809
9444-21
1.0
MAXFORCE
FCOEL
84240-14
2.15
PRECOR 1 %
PT 270
2724-352.50809
499-147
0078
.5
ROZOL BLUE
.0708
7173-172
.20
SAGA WP
432.755
.40
4816-707M
288912
2.7we
TEMPO 20 WP
3125-300
ULD BP-100
7.0
11540-TX-1
5.94
ZP TRACKING
152M/DER
12455-IBM
10.0
I TIME IN.- TIME OUT: t Received payment as follows:
-TOTAL:
AAI- / y� ( )CASH
AL: ,'4jjrfl I�•I FC) I/V) � 4i F � l-�D t&4j5( ) CHECK
): v taE.d„IpC.744 JO „ 71NTt f h4 -( ) CHARGE
MT h-(- ON 6.y /5 ( ) ON ACCOUNT
TECHNICIAN'S SIGNATURE: LICENSE d: 9. .7.'//7
Inderargned,authorized and agree the work listed has been pe rid as described and that I have received state
ad materials as checked.I further agree to pay all collection coifs,including reasonable attorney's fees and/or
on agency fees together with late charges on any unpaid balance beyond 15 days at a rate or 1 %%per month.
MER SIGNATURE: DATE: