Year NAME/ADDRESS OF SCHOOL / ILLINOIS DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH / Authority of the State / Illinois Department of Public Health / Division of Environmental Health / / /
Position
Employer Business Address Supervisor / inch Head / Supervisor / Governor / General / technician / STRUCTURAL PEST CONTROL TECHNICIAN / certified technician / /
ILLINOIS DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH 525 W. JEFFERSON ST. SPRINGFIELD, IL[removed]APPLICATION FOR CERTIFICATION AS A STRUCTURAL PEST CONTROL TECHNICIAN RESTRICTED-USE PESTICIDES