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�vSTOCKTON, CA 95205! _ <br /> Off. ,e : _( 209 )408=3300 Recorder . (NOI ) : (209 )468-3300 FAX: ( 209 , 30 <br /> RESTRICTED MATERIALS PERMIT PERMIT/OPERATOR T . D. # : 39-98-3902066 <br /> County HQ District # : J <br /> rORNASERO, TOM, Expiration Date . . 12/131/2000 <br /> 7681'4 LINNE ROAD Issue Date : 01/02/1998 <br /> TRACY, CA 95376- <br /> TOM FORNASERO Home : ( 209 ) 835-2997 <br /> 7681 W LINNE ROAD Shop: ( } - <br /> TRACY, CA 95376- Mobile : ( ) - <br /> - T---_-r-- FOR RESTRICTED MATERIALS PERMIT.' USE ONLY <br /> Permit Type : Poss . Only [ ] Seasonal [X] Poss . & Use [X] Job [ ] <br /> Permittee Type : Q.A. Cert [ ] Ag . PCO [ ] Private App [X] Non-Ag [ ] <br /> NOI required 24 hours prior to application. <br /> Method: Phone [X] Box [X] Person [X] Modem [ ] Fax [X] <br /> NumbW Pesticide Pest( s ) Form. Method( s ) 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 /> 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 /> � I <br /> Non-Ag Use: <br /> Conditions: PQW <br /> I 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 ori 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 <br /> used in 'the treatment . [Form 33-125/v3 . 53 (Rev. 02/16/90) Pesticide -Enforcement <br /> Branch] : ,J <br /> Permit Applicant: I40 #� Signer <br /> Title : �[hrin �`L .-- _ Date : <br /> Issuing Officer: <br /> Date D/- O2 _ g <br />