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1 <br />SAN J MIN <br />„i COUNTY— <br />Greatness Chows i)ere <br />OFFICE OF THE <br />AGRICULTURAL <br />COMMISSIONERISEALER <br />2019 APIARY REGISTRATION <br />Iz n ��it r rl <br />NAME: <br />ADDRESS: <br />CITY/STATE: <br />DATE APIARIES ARE LOCATED <br />TIM PELICAN <br />Agricultural Commissioner <br />Sealer of Weights d Measures <br />KAMAL BAGRI <br />Asst Agricultural Commissioner 8 <br />Asst. Sealer of Weights 8 Measures <br />COUNTY: SAN JOAQUIN DATE: Z4 ell <br />PH IKN 20Cl (BRAND: <br />E-MAIL:__ <br />IN THIS COUN <br />r)ATF RFFC \Alli I AAll\/r• t-�i iT r r- — i <br />.gal, <br />NUMBER Of- <br />COLONES <br />Describe location so it can be plotted on county map using roads, canal, interser_tions, giving direction, distance and <br />,ide of road or shnw Quarter Section. Township and Ranqe or GPS coordinates. <br />Please include map and physical address <br />(fo <br />uAonl) <br />i <br />I DO NOT WANT TO BE NOTIFIED BEFORE APPLICATIONS ARE MADE OF PESTICIDES KNOWN TO BE HARMFUL TO BEES. <br />REQUEST FOR PESTICIDE NOTIFICATION <br />I hereby request to be notified before pesticide applications are made as provided for in section 29101 of the <br />California Food and Agricultural Code and Title 3 California Code of Regulations section 6654. <br />I am available for notification during the two-hour timeeriod�fr�om12- <br />�� <br />each day by collect call to the following number(s� L�,- 08 or <br />I understand that if I fail to submit my request for pesticide notification to the Agricultural Commissioner IN <br />WRITING within the 72 -hour period before relocating, and if I fail to properly post an identification sign at my <br />apiaries or am not available for notification at the hours I have designated above, I may not be entitled to reco r <br />damages. I understand that this "REQUEST FOR NOT will expire Dec er 31 of this registratio <br />year. ' <br />���r��/ <br />DATE <br />For Office Use OnlyS f �f I <br />DATE RECEIVED _- <br />TYPE OF PAYMENT <br />0 COPY TO ACCTG <br />SIGNATURE OF BEEKE <br />CLERICAL INITIALS <br />REGISTERED IN OTHER CALIFORNIA COUNTY <br />MAIN OFFICE ""'r v <br />10 W. Locust SL,, Lodi 95240 <br />2101 E. Earhalt Avenue, Suite 100 P: 209-331-7287 F: 209531-7288 <br />Stockton, Califomia 95206-3924 <br />P: 209 9535000 F: 209-953-6022 <br />vu <br />17620 E. Hwy. 120, Ripon 95366 <br />P: 2094685542 F: 209-0685544 <br />