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SAN JOAQUIN COUNTY 'C-- ,, <br /> N.r868 E. HAZELTON AVENUE q�l , <br /> STOCKTON, CA 95205 Office: ( 209)468-3300 Recorder (NOI ) : ( 209 )468-3300 FAX: ( 209 )s0 <br /> RESTRICTED MATERIALS PERMIT PERMIT/OPERATOR I .D. #: 39-99-3902027 <br /> County HQ District # : J <br /> SHEA, H M Expiration Date: 1z-3f-/9fP <br /> P 0 BOX 1143 Issue Date: O/- DY-/974 <br /> TRACY, CA 95378- <br /> TOM SHEA Home: ( 209 )835-7451 <br /> P O BOX 1143 Shop: ( ) - <br /> TRACY, CA 95378- Mobile: ( ) <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> FOR RESTRICTED MATERIALS PERMIT USE ONLY <br /> Permit Type: Foss . Only ( ] Seasonal [X] Poss . & Use [X] Job ( ] <br /> Permittee Type : Q.A. Cert [ ] Ag. PCO [ ] Private App [X] Non-Ag' ( ] <br /> NOI required 24 hours prior to application. <br /> Method: Phone [X] Box [X] Person [X] Modem [ ] Fax [X] <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> Numb Pesticide Pest(s) Form. Method(s) Applicator( s) <br /> ----- --------------- ------------ -------- ---------------- ----------------- <br /> 201 AMINO TRIAZOLE Weeds Liquid Ground FCO Grower <br /> 1051 SEVIN Larvae Liquid Air Ground PCC Grower <br /> 1360 CHLOROPICRIN Nematode Fumigant Ground PCO Grower <br /> 3141 GUTHION Mites Liquid Air Ground PCG Grower <br /> 3830 METHOMYL Larvae Liquid Air Ground PCO Grower <br /> 3850 METHYL BROMIDE Soil/Stored Fumigant Ground PCO Grower <br /> 4840 ALUMINUM PHOSPH Rodents Fumigant Ground PCO Grower <br /> 5540 STRYCHNINE Gophers Bait Ground PCO Grower <br /> 6260 ZINC PHOSPHIDE Rodents Bait Air Ground FCO Grower <br /> 7860 MCPA, DIMETHYLA Weeds Liquid Air Ground PCG Grower <br /> 9801 2 , 4-D AMINE Weeds Liquid Air Ground PCO Grower <br /> 16011 PARAQUAT Weeds Liquid Air Ground PCO Grower <br /> 16891 SUPRACIDE Larvae Liquid Air Ground PCO Grower <br /> 19441 BASAGRAN Liquid Ground PCO Grower <br /> ** Pesticides continued on next page *** <br /> Nor,-Ag Use : <br /> Conditions : PQW <br /> ------------------------------------------------------------------------------ <br /> I understand that tris permit does not relieve me from liability for any damage <br /> to persons or property caused by the use of these pesticides . I waive any <br /> claim of liability for damages against the County Department of Agriculture <br /> based on the issuance of this permit. I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacturer' s <br /> labeling or in violation of applicable laws , regulations and specific <br /> conditions of this permit . I authorize inspection at all reasonable times and <br /> whenever an emergency exists, , by the Department of Pesticide. Regulation or the <br /> County Department of Agriculture of all areas treated or to be treated, storage <br /> facilities for pesticides or emptied containers and equipment u d or to be <br /> used in the treatment. [Form 33-125/x3 . 53 (Rev. 02/16/90 ) icide En rcement <br /> Branch] <br /> Permit Applicant :] V s� 1� Sign: <br /> Title: Date: <br /> Issuing Officer : Date : <br />