Request for Advance Notification of Pesticide Application

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Dear Parent / Guardian:

Complete this form ONLY if you are requesting advance notification of a pesticide application by United States Postal Service first-class mail. Please be advised that you WILL receive notice via the methods identified in the annual advisory notice and should only complete this form if you are also requesting notification by first-class mail.

If you are requesting prior notification of pesticide treatments conducted at this school or day care center, other than a bait or gel formulation, and you would like the notice to be delivered by United States Postal Service first-class mail, postmarked at least 3 days prior to the planned treatment, please complete the information on the following form and submit to:

Russel Woodruff
16911 Eastland
Roseville, MI 48066

I wish to receive a prior notice of any pesticide application to the school or daycare center by first-class mail.