Request for Pesticide Notification
SS. Peter & Paul School
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Dear Parent or Guardian,

A Minnesota state law went into effect in the year 2000 that requires schools to inform parents and guardians if they apply certain pesticides on school property.

Specifically, this law requires schools that apply these pesticides to maintain an estimated schedule of pesticide applications and to make the schedule available to parents or guardians for review of copying at each school office. At present we apply Demand CS insecticide (EPA-10182-361) four times a year. We use it to prevent ants, roaches, and spiders. We have scheduled the following dates for application: Sept. 9(4pm), Dec. 9(4pm), March 10(4pm), and June 9th. In addition we may fertilize the lawns the first week of September and the final week of May.

State law also requires that you be told that the long-term health effects on the children from the application of such pesticides or the class of chemicals to which they belong may not be fully understood. The Material Saftey Data sheet currently has the following information: The material is classified as "practically nontoxic" by ingestion. This material maybe slightly irritating to human eyes following contact. Short contact periods with human skin are not usually associated with skin irritaion. Toxic effects are not likely to develop after inhalation of Demand CS at residential dilution. No other adverse clinical effects have been associated with exposures to this material.

If you would like to be notified prior to pesticide applications made on days other than those specified in the estimated schedule (excluding emergency applications), please complete and return the form below and mail it to: Jacqueline L. Walz, SS. Peter & Paul School, P.O. Box 189, Richmond, MN 56368. If you have any questions regarding this notice, please contact Jacqueline Walz at 597-2565.

Sincerely,

Jacqueline L. Walz

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Request for Pesticide Notifaction

SS. Peter and Paul School

I understand that the school will make available an estimated schedule of pesticide applications for review and copying at the school office. Should a pesticide application be scheduled on a day different from the day(s) specified in the original schedule, I would like to be notified. I understand that the school may ask me for reimbursement for the cost of notification.

I would prefer to be notified by (circle): US Mail · E-mail

Please Print neatly:

Name of Parent/Guardian: __________________________________________________Date:__________


Address:  __________________________________________________________________

Day Phone  (____)___________Evening Phone(____)____________E-mail_____________________________

Return to:
Jacqueline L. Walz, principal
SS. Peter and Paul School
P.O. Box 189 Richmond, MN 56368