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PESTICIDE SENSITIVITY REPORT FORM

While conducting our mosquito control efforts it may be possible for us to limit or reduce applying insecticides (mosquito adulticides) on your property. If you would like to be placed on our "Pesticide Sensitivity List" please fill out the online submission form below. In the case of a public health emergency, properties on the List may require treatment to control adult mosquitoes and property owners will be given ample notification to make alternate plans if necessary.

* Indicates required field
  
*Street number (address):
*Street Direction:
*Street Name:
*Street type:
*City:
Zip:
*First Name:
*Last Name:
*Day Phone:
Evening Phone:
*Email:
Mailing Address
(if different from location address):
Mailing City:
Mailing State:
Mailing Zip:
Comments:

Thank you!

Confidentiality Policy

Information that you give us is confidential, so we will not reveal the source of a complaint. It is important that you give us your name, phone number and address so that Multnomah County Vector and Nuisance Control can contact you for the following reasons:

Vector Home Page | Environmental Health Section | Health Department | Multnomah County

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The address for this site is: http://www.mchealth.org/vector/deadbird.html
Created: May 07, 2003
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