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`Zeatricted Materials Prem ' Conditions Page#: 1 of 3 <br />L <br />The Following Conditions Apply To ..................... Permit#: 39-03-3903417 <br />WORKERS SAFETY SERIES ATTACHED - - <br />---------------------------------------------- - <br />-------------- ------ <br />-------------------------------------------------------------------------------- <br />[v] A-1 through A-9 General Info. I C_7 B-1 Cholinesterase Testing <br />----- --- ---- <br />=_ -------------= ----=--------------------------------- <br />-PERMIT-CONDITIONS ATTACHED <br />L------ -------------------------- ---------------------- <br />---------------- <br />[X] P General <br />LX] O - DICamba & Pheno..y Herbicides - Central Valley/iiazardcus Area <br />LL_J R - Dicamba & PhenoxYs - Special Hazardous Area <br />S - Me.tam Sodium & Me -am Potassium <br />T - Aldicarb (Temik) <br />L[_] U - Endosulfan (Thiodan:) <br />[_] V - Rice Pesticides Program <br />[_] Molinate (Ordram) Worker Safety <br />C_7 Attachments 1-9: Molinate (1,6) thiobenc.arb (2,6,7), carbofuran <br />(316), methylparathion (4,9) and malathion (voluntary: 5,8) <br />{_] W - Methyl Bromide <br />[_] Soil within greenhouses <br />[_J Commodity <br />[_J Soil injection <br />[_] Tarped potting soil <br />C_] Single tree site <br />[_] X - Furadan chemigation of grapes <br />[_] Z - Other <br />r <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 agricultural, outdoor institutional or outdoor industrial <br />" use. <br />C_7 <br />The material I am purchasing will be used in a Pesticide Management Zane <br />(as described in Section 6802, Title 3, California Code of Regulationsi <br />for agricultural, outdoor institutional or outdoor industrial use and a <br />copy of my restricted materials permit is attached. <br />Material purchased: C_J Atrazine [_] Simazine C_7 Bromacil <br />[_] Diuron C_7 Prometon C_] 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 institutior-a'_ or <br />outdoor industrial uses except in accordance with a permit -,Y the <br />county agricultural commissioner or the director in a courik.Y ": which <br />the is no commissioner. <br />Date <br />L <br />