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F.:' <br /> F <br /> STATF OF CAIiFORNIA o2z&A'UENTCF'fiSTIC:C4�c4iULATIM, <br /> PRIVATE APPLICATOR GICEENFORCe IENT3AANCr <br /> + CERTIFICATION STATEMENT <br /> P11•ENF-172IREV. W"I i/ - CcA,7 A ^Nall"ATIONCAic <br /> < <-�-7<//9 <br /> IVATcAPPLICATORNAME T + _•' -G.A'z'C'.NE.`i[iF+IBEa <br /> P <br /> A CAESS Y <br /> rf <br /> C ATiFYING COUNTY NAME I PERMIT NUMBER ISSUED I C:::Yi'=LC`:E NUMflErZ <br /> CEATI'r1CA_nOP P5RMIT ISSUED BY: ItTLEI j <br /> if J <br /> y CERTIFICATION TYPElOATE ISSUE4: <br /> -,.F71 GENERAL EXAMINATION -`�VC;;KEa SAF-z Y EXAM1NATICN C ORAL�dALL'ATiON <br /> DATE: <br /> f <br /> DATE: ', .� DAY=. <br /> 1 <br /> [ PE37iCICE SAFciY SEr"iIES INFORMATION PROVICEC: PE5TFG:CE SAFE SEAico iNFORMATiCN(SERIES NUMBE3{S]PI70VICE01: <br /> U YES NO <br /> �- l certify the above information is correct and "-at,: rave taken the Private Applicator Certification examiraticr, for the possession <br /> and/or use of restricted use pesticides. i have reviewed and understand questions answered incorrectly ;with the issuing scurry. <br /> CERTIFIED PRIVATE APPLICATOR S ATURE ri'< ;3Z.,E�CER nP'G0 <br /> Oistrihuuon: Original—County Canary—Certified Private Appbcaror Prix —Copy <br /> �a <br /> i <br />