CONSUMER INFORMATION NOTICE
Consumer Information Notice
Applicator or Applicator Business Name: ______________________________________________
Address: _____________________________________________________________
Phone: ____________________________________
Dear Customer:
The New Jersey Department of Environmental Protection Pesticide Control Program requires us to provide customers with information about the materials that we will be using as part of the pest control program for your property. We are using this Consumer Information Notice to provide you with this information.
Sanitation, as well as physical and biological control measures, should be considered as part of a good pest control program. Pesticides may be used as another part of a good pest control program. Pesticides are substances used to control living organisms and vary in degree of toxicity.
We will apply the pesticides listed below to your property as part of your pest management program. If we provide you advance notice of possible pesticides to be used, we will subsequently leave written notice of the specific pesticide used on the application date. The exact dates of application shall be made available to you if you request it. Additionally, you may request a copy of the label for each pesticide that we will use. In certain cases, we will provide you label precautions relating to resident or general public safety to follow prior to and/or following application of individual pesticides.
Brand Name Common Chemical Name
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
You will also notice that, following each application, at least one sign will be placed on your property that says PESTICIDE TREATED AREA and contains the international signage, keep off the grass. The sign(s) must remain in place for at least 72 hours following the application and we are responsible for removing the sign within 72 hours following application. We would appreciate it if you would remove the signs for us.
We are also required to provide the following phone numbers for your use in the event you have questions concerning the materials that we will be using:
• NATIONAL PESTICIDE INFORMATION CENTER: (800) 858-7378. For general health and pesticide toxicology questions.
• NEW JERSEY POISON INFORMATION & EDUCATION SYSTEM: (800) 222-1222. For emergency situations.
• NEW JERSEY PESTICIDE CONTROL PROGRAM (609) 984-6507. This number is for pesticide regulatory information and pesticide complaints.
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Please sign and return this portion of the Consumer Information Notice to us for inclusion in our records.
As the customer, I hereby certify that __________________________________ has provided me, in writing, all the information
Required under the NJDEP Pesticide Control Program’s notification program. I have read the information supplied and understand
my rights and responsibilities under this program. I also agree to remove the notification sign(s) that they will post on my property,
no sooner than 72 hours following each application.
Signed: _________________________________ Date: __________
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