Fumigation Notification Form

Structural Pest Office
pest@agr.georgia.gov Tel: (404) 656-3641 Fax: (404) 463-6671

To comply with chapter 620-8-02 of the Georgia Structural Pest Control Act Notification Requirement, the licensee shall notify Georgia Department of Agriculture at least 48 hours prior to the scheduled time of release of fumigant. To notify GDA of the release of a fumigant, please complete and submit the form below.

Company Name

License #

Property Owner

Address

City/Town

State/Province

ZIP/Postal Code

County

Type of Structure

Type of Foundation

(Check all that apply)

Slab

Basement

Crawl Space

Operator in Charge

Day Phone

Night Phone

Fumigant

Cubic Feet

Target Pest(s)

Date / Time of Releasement

Exposure

CAPTCHA

Fumigation Notification Form

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