PMCM Form-069 / Rev.

0 / 6 April 2016

PMQS CONSTRUCTION SOLUTIONS, INC.

INSPECTION REQUEST TERMITE AND PEST CONTROL

PROJECT NAME : CONTRACTOR :

LOCATION : DATE REQUESTED : :
CLIENT : BUILDING IDENTIFICATION :

Area of Application/Location : ACTION CODE:

Application Rates : Approved
Chemical Manufacture Date : Approved subject to comments, works may proceed.
Chemical Expiration Date : For Reinspection
Warranty Period : Disapproved, works cannot proceed

A. APPLICABLE SPECIFICATIONS: SECTION

B. CONSTRUCTION METHOD/APPLICATION:

REMARKS
1. Site preparation
2. Safety precaution measures
3. Total area covered
4. Others, please specify

NOTE: SIGNATURE OVER PRINTED NAME, INDICATE COMPANY & DATE SIGNED
CONTRACTOR: INSPECTED BY:

REPRESENTATIVE PMQS SITE ENGINEER

APPROVED BY:

PMQS CONSTRUCTION MANAGER

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