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I <br /> SAN JOAQUIN COUNTY <br /> 1868 E. HAZELTON AVENUE <br /> + STOCKTON, CA 95205 . <br /> Office: (209)468--3300 Recorder (NOI ) : (209)468-3300 FAX: (209)468-3330 <br /> RESTRICTED MATERIALS PERMIT Permit#: 39-01-3902066 <br /> County HQ District#: J <br /> FORNASERO, TOM Expiration Date: 12/31/2001. <br /> 7681 W LINNE RD Effective Date : 01/08/2001 <br /> TRACY, CA 95376- <br /> TOM FORNASERO Home: (209)835--2997 <br /> 7681 gni LINNE RD Shop: ( ) - <br /> TRACY, CA 95376- Fax: 832-2370 <br /> Mobile: <br /> Permittee Type - Permit-Type - Possession NOI Method of Submission <br /> -------------- ------------ -------------- --------------------------- <br /> � ' Private App [X] Seasonal CX] Poss & Use CX] Phone LX] Fax CX] <br /> j Q A Cert C ] Job [ ] Poss Only C ] Box [X] Modem [ ] <br /> Ag PCO [ 7 In Person CX] <br /> Non-Ag C ] NOI required 24 hours prior to application <br /> NumbPesticide - --Pest(s) Form. r Method(B) Applicator(s) <br /> __---, --------------- ------------- --------- ---------------- ----------------- <br /> 1360 CHLOROPICRIN NEMATODE Fumigant Fumigate PCO Grower <br /> 3141 GUTHION MITES Liquid Air Ground PCO Grower <br /> 3824 METASYSTOX-R APHID Liquid Air Ground PCO Grower <br /> 3850 - METHYL BROMIDE SOIL/STORED Fumigant Fumigate PCO Grower <br /> k� 3940 METHYL PARATHIO LARVAE Liquid Air Ground PCO Grower <br /> 4840 ALUMINUM PHOSPH RODENTS Fumigant Ground PCO Grower <br /> 9801 2,4-D AMINE WEEDS Liquid Ground PCO Grower <br /> 16011 PARAQUAT WEEDS Liquid Ground PCO Grower <br /> 16891 SUPRACIDE LARVAE Liquid Air Ground PCO Grower <br /> r Non-Ag Use <br /> Conditions: PQWZ <br /> T understand that this permit does not relieve me from liability for any damage <br /> to persons or property caused by the use of these pesticides. I waive any <br /> claim of liability for damages against the County Department of Agriculture <br /> based on the issuance of this permit. I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacturer's <br /> labeling or in violation of applicable laws, regulations and specific <br /> conditions of this permit. I authorize inspection at all reasonable times and <br /> whenever an emergency exists, by the Department of Pesticide Regulation or the <br /> County Department of Agriculture of all areas treated or to be treated, storage <br /> facilities for pesticides or emptied containers and equipment used or to be use, <br /> in the treatment. [Form PR-ENF-125 (Rev. 07/92) Pesticide Enforcement Branch] <br /> Permit' Applicant: �i gkiPS`C21l _ Sign: �f <br /> Title: Date: <br /> Issuing Officer: �" Date: �� <br />