Pest Control Request Form

Texas Tech University

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DHS-Appendix A of the CFACTS

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Please read the following instructions carefully:

Please fill out the form completely - incomplete forms will result in delays.
Also a copy of your pest control request will be sent to you by email after you fill out the request form.
Once the form is submitted, it will be reviewed by EH&S and the treatment will be scheduled accordingly.
If you have any questions, please contact EH&S at 742-3876.
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`Request Date`	date(MM/DD/YYYY)
`Requestor Name`	enter your name; room number
`Requestor Room #`
`Requestor Phone No`	enter your phone number (xxx-xxx-xxxx)
`Department`	enter your department name
`Building Name`	enter building name
`Room(s)to be Sprayed`	enter room number(s) (eg. 123-126, 140)
`Email`	enter your email (eg. Krish.Raya@TTU.EDU)
`Pest Problem`	enter description of problem(max 500 characters)

For additional Information contact EH&S at 742-3876. If you have any problems/comments with this form contact webmaster.


	Environmental Health and Safety \| 2903 4TH Street Rm 122 \| Lubbock \| Texas 79409-1090 Phone: 806.742.3876 \| Fax: 806.742.3895 \| Maintain By: Abdullah Muqim Copyright 2009 Texas Tech University \| All Rights Reserved \| Last Updated 05.14.2009