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�../ SAN JOAQUIN COUNTY '1 goo 2 / 18 6 8 E . HAZELTON 9A VENUE STOCKTON, CA Web URL:www.co.san-joaquin.ca.us/agcomm E -Mail : Recorder (NOI):(209)468-3300 FAX:(209)463-3330 ✓,Office :(209)468-3300 : 39-02-3908051 OPERATOR/SITE I.D.I D. County HQ District #: C pEF�.TOFISZTE IDEDiTIFICATION NUMBER r DE ROUSSE, 9345 S. ROAD 95230 FAAMINGTON. CA KEITH DE ROUSSE 9345 S. HENRY ROAD FARMINGTON, CA 95230 v Expiration Date: 12/31!2002 Effective Date : 01/�/ Home: (209)886-0073 Shop: Fax: Mobile : Non -Ag Use: None Conditions: No Conditions permit does not relieve me from liability for any damage caused by the use of these pesticides- Z riculturve e I understand that. this p Department of •z3 to persons or property Permit claim of liability for damages against the County Dep based on the issuance of this permit. I further understanthe manufacturer's d that this in n flict with may be revoked in when pesticides are licableusedlawscoregulations end specific times labeling or in violation of app at all reasonable times an conditions of this permit. I authorize inspection whenever an emergency exists, by the Department of Pesticide Regulation or the County tied containers and equipment used or to be uses Department of Agriculture of all areas treated or to be treated, storage uss facilities for pesticides or amp pesticide En orcement Branch] in the treatment. (Form PR-ENF-125 (Rev. 07/92) V 'x=172✓ o Sign: p� permit Applicant: t -�Q l� Z .. Title: OVJ1- P- Issue Date: ` Issue Date: Issuing officer: page 1 r r NOI Method of Submission rPermittee Type Fermat nfPe- Possession ______________ -----------------Fax I I - I 1 -------- Seasonal IXI Poss 6 Use IXI Phone Box I I Modem I I Private App I I I i Job I I Poss Only 1 I In Person I I we I I lication {}A Cert IXI required 24 hours app ___-_-- r.Ag P�-O NOI -prior -to- Non -Ag I I Non -Ag Use: None Conditions: No Conditions permit does not relieve me from liability for any damage caused by the use of these pesticides- Z riculturve e I understand that. this p Department of •z3 to persons or property Permit claim of liability for damages against the County Dep based on the issuance of this permit. I further understanthe manufacturer's d that this in n flict with may be revoked in when pesticides are licableusedlawscoregulations end specific times labeling or in violation of app at all reasonable times an conditions of this permit. I authorize inspection whenever an emergency exists, by the Department of Pesticide Regulation or the County tied containers and equipment used or to be uses Department of Agriculture of all areas treated or to be treated, storage uss facilities for pesticides or amp pesticide En orcement Branch] in the treatment. (Form PR-ENF-125 (Rev. 07/92) V 'x=172✓ o Sign: p� permit Applicant: t -�Q l� Z .. Title: OVJ1- P- Issue Date: ` Issue Date: Issuing officer: page 1 r r