Section 11763 Of Article 3. Report Of Damage From Pesticides From California Food And Agricultural Code >> Division 6. >> Chapter 4. >> Article 3.

. The verified report of loss, nonperformance, or damage shall set forth, so far as known to the claimant, all of the following:
  (a) Name and address of the claimant.
  (b) Type, kind and location of property which is allegedly injured or damaged.
  (c) Date the alleged loss, nonperformance, or damage occurred.
  (d) Name of pest control operator that is allegedly responsible.
  (e) Name of the owner or occupant of the property for whom the person or pest control operator was rendering labor or services.