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Mosquito Control Service Request Form
SERVICE REQUEST
MOSQUITOFISH
CONTACT US
FOGGING SCHEDULE
Submitted by
Administrator
on May 26, 2014 - 1:33am
Use this form to request mosquito control related information or services from the district.
First Name
*
Last Name
*
Company Name
Phone
*
Email Address
*
It is OK to Contact Me via Email
Yes
House Number
Street
City
Zip Code
Nearest Cross Street
Mosquito Problem
I Have a Mosquito Problem
Permission to Check/Treat as Needed
No
Yes
Do you give Benton County Mosquito Control permission to enter your property without you being present at the time?
Are Mosquitoes Biting?
No
Yes
When Are They Biting?
Morning
Day
Dusk
Night
Select all times in which mosquitoes are biting
Where Are They Biting?
Indoors
Outdoors
Indicate where you are encountering mosquitoes
Mosquito Problem Details
Please enter any other details that may help us resolve this issue
Water Site to Check
I Have a Water Site to Check
Do you own the property that this water site is located upon?
No
Yes
Permission to Treat Water Site
No
Yes
Do you give Benton County Mosquito Control permission to enter your property without you being present at the time?
Can you provide us with owner’s contact information?
Please provide a detailed description as to the location of the water site you would like us to survey
Please check any boxes that apply to this water site:
I suspect that mosquitoes are present
I am concerned that mosquitoes could develop at the site
I would like guidance on what I can do to limit or negate mosquito development at this site
Are there any gates we need to go through or fences to cross to get to the water site?
No
Yes
Please describe gate location or fence type and best entry point
Are there any pets or livestock that we need to be aware of near the water site?
No
Yes
Please tell us what animals we should expect and any related information
Mosquitofish (Gambusia)
I am Interested in Mosquitofish
Do you own the property where the mosquitofish will be placed?
No
Yes
Can you provide us with owner’s contact information?
Initials
Initials
(REQUIRED for delivery)
I have read and understand the terms for delivery below
Yes (REQUIRED for delivery)
“Gambusia affinis is not an indigenous (native) species to Washington. Benton County Mosquito Control District #1 has been given permission by the Washington State Department of Fish and Wildlife (WDFW) to use Gambusia as a biological control method for mosquito larvae. We, therefore inspect potential sites before we transport any Gambusia to that area. It is illegal for any person not authorized by the WDFW to transport, distribute or introduce Gambusia into any water site.”
Permission to Place Fish
No
Yes
Do you give Benton County Mosquito Control permission to enter your property without you being present at the time?
Please provide a detailed description of the water site (size, gallons, etc.)
Are there any gates we need to go through or fences to cross to get to the mosquitofish site?
No
Yes
Please describe gate location or fence type and best entry point
Are there any pets or livestock that we need to be aware of near the mosquitofish site?
No
Yes
Please tell us what animals we should expect and any related information
Additional Information
I Would Like Additional Information
Please provide us with a brief description of the information you would like
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