OFFICIAL WAIVER
of the Georgia Minimum Treatment Standards for the Control of Subterranean Termites
NOTICE TO PROPERTY OWNERS/AGENT
DO NOT SIGN THIS DOCUMENT UNTIL YOU HAVE READ AND SIGNED "CONDITIONS GOVERNING THE USE OF OFFICIAL WAIVER OF THE MINIMUM TREATMENT STANDARDS FOR THE CONTROL OF SUBTERRANEAN TERMITES" ON THE REVERSE SIDE OF THIS DOCUMENT. THESE "CONDITIONS" MUST BE CONSIDERED PART OF THIS DOCUMENT. YOU MUST RECEIVE A COPY OF THIS REPORT AND SUPPORTING GRAPH AT TIME OF SIGNING OR SERVICE.
Name of Company ____________________
Address of Company _____________________________________________________
Owner of Property ____________________
Inspector name and certification/registration number _____________________________
Address of Structure Treated - Note: A separate Official Waiver is required for each individual structure. Reproductions of the Official Waiver for multiple structures is not acceptable.
________________________________________________________________________
Phone Number of Property Owner/Agent ____________________________________
Indicate with a check mark those items that do NOT meet the minimum treatment standards.
TERMITE CONTROL
SOIL TREATMENTS - Note: For defined post construction soil treatments and preconstruction soil treatments, only items # 1, 2, and 3 are applicable.
Type of treatment - Check one
Comprehensive post construction soil treatment _____
Defined post construction soil treatments _____
Pre-construction soil treatment _____
Date Job Completed ________ NO
Non Soil Pesticide, Device, Bait or Baiting System - Note: All items pertain to both post-construction and pre-construction applications.
Date Job Completed ________ NO
Explain in detail what areas of the structure do not meet treatment standards and why it is not possible to meet these treatment standards. Also, attach a graph indicating the area(s) that were not treated to minimum standards. Failure to attach a graph and provide a detailed written explanation will void this document. Use other side if necessary.
____________________________________
____________________________________
____________________________________
Signature of Property Owner/Agent _________________________
Date ____________
Revised 04/14 - Replaces all previous editions
CONDITIONS GOVERNING THE USE OF THE OFFICIAL WAIVER OF THE MINIMUM TREATMENT STANDARDS FOR THE CONTROL OF SUBTERRANEAN TERMITES
Additional Explanations
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
Signature of Property Owner/Agent_________________________
Date ____________
Revised 04/14 - Replaces all previous editions
The Licensee shall return the Inspection and WDO Corrective Action Report to the Enforcement Agency within thirty (30) days of its receipt confirming to the Enforcement Agency that all reported deviations from the Minimum Adequate Treatment Standards have been corrected.
Ga. Comp. R. & Regs. R. 620-6-.07
O.C.G.A. § 43-45-8.