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4 <br /> RESTRrCTED MATERIALS PERMIT ccnnlnued pagee# : <br /> J V FARMS Permi :r . 3?-02-Z903674 <br /> ,� S <br /> WCRKER <br /> S - -- ;ESE7 <br /> 1 __ ----------------------- - ----- - ------- <br /> ._ __-_-____-----__--------- <br /> [x] A-1 through A-9 General into . C_1 B-1 Cholinesterases eating <br /> PERU C01+!GiT1%iJ AiTACt-1ED <br /> ----------------------------------------------------- <br /> [x] P - General <br /> CX] Q - Dicamba & Phencxy Herbicides - Central Valley Hazardous -- . _a <br /> C,3 R - Dicamba & Phenoxys - Special Hazardous Area <br /> f� S - Metam Sodium (Vapam) <br /> f� T - Aldicarb (Temik) <br /> F. U - Endosulfan (Thiodan) <br /> 1 , C_] V - Rice Pesticides Program <br /> CA Mali,nate (Ordram Worker Eafa y <br /> [� Attachments 1-9 : Mclinats ( 1 ,6) t`iobencarb (2, 6 , carbofuran <br /> (3 , 6) , mathylparathion (4, 9) and malathion (vcluna.r . S,W) <br /> CX] W - Methyl Bromide <br /> [_J Soil within areenhcuses <br /> C_„] Commodity <br /> C_J Sail injection <br /> C_] Tarped patting soil <br /> [_J Single tree site <br /> [� X - Furadan chemigation or grapes <br /> CJ Z - Other <br /> _____---- ----------PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ___--------------------------------------------------------------------------- -- <br /> [ The material I am purchasing will not be used in a Pesticide Management <br /> Zone (as described in Section 6802, Title 3, California Code of Reg- <br /> ulations) for agricul- raj , outdoor institutional or outdoor industrial <br /> use . <br /> C_J The material I am purchasing will be used in a Pesticide Management Zone <br /> (as described in Section 6802, Title 3, California Code of Regulations) <br /> for agricultural , outdoor institutional or outdoor industrial use and a <br /> copy of my restricted materials permit is attached. <br /> Material purchased: CJ Atrazine C_J Simazine CJ Bromacil <br /> [_2 Diuron C_J Prometon Bentazon <br /> I Certify under penalty of perjury that the foregoing statement is true, <br /> and that I will not apply any material listed in Section 6800(a) in any <br /> Pesticide Management Zone for agriculture, outdoor institutional or <br /> outdoor industrial uses except in accordance with a permit issued by the <br /> county agricultural commissioner or the director in a county in which <br /> there is no commissioner . <br /> `� _ - _____- -------- 1 -- --- <br /> ' ' Date <br /> Purchaser <br />