Dear Parent or Guardian,

At your request, we are writing to notify you about a specific pesticide application(s) at your child’s school. Please see below for detailed information. If you would like to see the Material Safety Data Sheet for this chemical, it is available at your child’s school Office. If you have any questions, please contact the District Grounds Manager, at 619-425-9600 ext. 1420.

Sincerely,Joseph C. DombrowskiGrounds Manager ______________________________________________________________________

Notice of Pesticide Application

Date Form Completed: ______________September 7, 2012 __________________________

School Name: ________ALLEN ELEMENTARY___________________ ____ __________

Location of Planned Pesticide Application: _____ ROOM 201 &203____________ _

Building Name/Number: __________200 BUILDIG ______________________

Playground or Grounds Section: __________ AS NEEDED _________________________

Name of Pesticide to Be Applied: _________TEMPO ULTRA WP_____________________

Active Ingredient(s): __(8 Cyfluthrin Cyano, Methyl 3, Dimethylcyclo) 10%, OTHER 90%__

Planned Date/Time of Pesticide Application: ________September 8, 2012___________

For more information regarding these pesticides and pesticide use reduction, visit the Department of Pesticide Regulation’s Web site at http://www.cdpr.ca.gov and click School IPM Program.

**If there is inclement weather, spraying will be done the following weekend.Note: Re-entry when dry.