Laserfiche WebLink
CAI <br /> Restricted Materials !'2 _ ccnas __: ns Faces : 1 of 7 <br /> The-Following rConditions-Apply <br /> Formi'=y03_-J9=_c7= <br /> WORKERS SAFETY SERIES ATTACHED <br /> _C X 1 A-1 -through-A-4 Genera i-- 4w . ----------3-1 Cho 1 ;nesterase-rc s ingf------ ' <br /> ---_-----_------_-__.--�_==-=r7-c_ =i'dI+ MS_a T T?.Cry.. <br /> - ineral <br /> Al------- --- -----------------~--- -'-1=-------------------------------------- <br /> i r! Gicamba & Phenoxy Harts _ es Central Valley/Hazardous Qraa <br /> C_] R -- Dicamba & Fhenoxys - Special Hazardous Area <br /> [_] S - MetAm Sodium & Metam potassium <br /> -_i T - Aldicarb ( T`mik ) <br /> !__' u - Endosul fan ( Thiodan ) <br /> V - Rice Pesticides Program _ _ <br /> C_1 Molinate Mrdram ) Worker :safe;,, <br /> C_] Attachments <br /> � 1-7 : !clina,^te ( ? .= <br /> , ) thiobe:--!card (?,S , r , _arboluran <br /> (3, 6 ) , m e r f i y l p a it l i o i (4 7 a n d malathion lvolun a• y 5 <br /> E i W - Methyl Bromide <br /> _s Soil within tin greenhouses <br /> EJ Cammoci '= <br /> E_] Soil injection r <br /> CJ_] arped patting so- : <br /> EJ Single tree site <br /> EJ X - =uradan c`amig.ation, c4 :grapes <br /> PESTICIDc wi=i_„r .--Gr<G:UNDWFi T Erc-PRf1 T car-IChl <br /> The material-I am purchas;yg-will-not be used in a Pesticides-Management -- <br /> l Zone (as described in Section 6602, Title 3, California Core c' Reg- <br /> ulations ) for agricultural , outdoor institutional or outdoor industrial <br /> use . <br /> C_] The material I am purcha=_int, will be used in a. Pesticide Marn7r lent Zone <br /> (as described in Section 6602, title Z, 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 : [_] Atrazine i_] Simazine C_] Srcmacil <br /> C_a Di.utron [_] Prometon C_] Bertazon <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 6200 ( 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 /> Purchaser Date <br /> EJ <br />