Exp.

12/12/13

OMB Approval No 9991-2123

Construction Subterranean Termite Soil Treatment Record

Section 1:General Information (Treating Company Name)

Company Name : FAIV ES ATDEKEYVE CORPORATION

Company Adress : NO.92 JALAN PUTERI HEIGHT,BANDAR COUNTRY HOMES. City : RAWANG. State : SELANGOR. Zip :48000
Company Business License No :______________________________________

Company Phone No : 03-4568897

FHA/VA Case No. (if any) :

Section 2:Builder Information

Company Name : GEV ALOBBI SKETS CORPORATION. Phone No.: 03-1302447

Section 3:Property Information

Location of Structure(s) Treated (Street Adress or Legal Description,City,State and Zip)
Type of Construction (More than one box may be cheked) Slab yes_

Basement ___ Crawl___ Other___(describe it)____________________

_____________________

Approximate Depth of Footing: Outside_________________ Inside_________________ Type of Fill___________________________________

Section 4: Treatment Information

Date(s) of Treatments(s) :__________________________________________________________________________________________________
Brand Name of Product(s) Used :____________________________________________________________________________________________
EPA Regstration No. :_____________________________________________
Approximate Final Mix Solution :___________________________________
Approximate Size of Treatment Area : Sq ft. __________

Linear ft. _____________

Linear Ft. of Masenry Voids ___________________________

Approximate Total Gallons of Solution Applied :___________________________

Form NPCA-99-B may still be used

Form HUD-NPCA-99-B (03/2004)

Exp. 12/12/13

OMB Approval No 9991-2123

Was treatment completed on exterior? ___

Service Agreement Available? ___
Note : Some state laws require service agreements to be issued.This form does not preempt state law.

Attachments (list) ______________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________
Comments
________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________
Name of applicator(s) ____________________________________________________________________________________________________
Certilfications No. (if required if State Law)___________________________________
The applicator has used a product in accordance with the product label and state requirements.All treatment materials and method used comply with state and federal regulations.
Authorized signature__________________________________________________________________

Date____________________________

Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1026, 1005. 1092; 17 U.S.C. 17263.1586)

Form NPCA-99-B may still be used

Form HUD-NPCA-99-B (03/2004)