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i <br /> 6. 2003 ✓ <br /> LSAN JOAQUIN COUNTY <br /> 1868 E . HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> i <br /> Web URL :www . co . san-joaquin , ca . us�agcomm <br /> i.. <br /> E-mail <br /> Office : ( 209 ) 463--3300 Recorder (NOI ) : ( 209 ) 468--3300 FAX. ( 209 ) 468-3330 <br /> RESTRICTED MATERIALS PERMIT PERMIT # : 39-03-3900391 <br /> County HQ District # : H <br /> V ROLLERI . VICTOR Expiration Date : 12131/200_ <br /> 5113 E MAIN ST Effe,._tive Date . <br /> STOCKTON, CA 95205 <br /> L / <br /> VICTOR ROLLERI Home t209 ) 463--8486 <br /> 5113 E MAIN ST Shop : 1 ) - <br /> STOCKTON. CA 95205 Fax : <br /> 6W Mobile ( ) - <br /> ------------------------------------------------------------------- <br /> L <br /> Permittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> j Private App 1XI Seasonal JX( Pose & Use 1X! Phone )XJ Fax 1XI <br /> '.. Q A Cert I ± Job I I Poss Only f. j Lox I ) Modem jXI <br /> Ag PCO In Person )XI Web 1XI <br /> Non=Ag NOI required 24 hours prior to application <br /> Nan-Ag Use : Gone <br /> Conditions : PQ <br /> I under t�nr.i lh, t ttii pF•rmit r.c,t-Le�lieve-me horn liability fur any damage <br /> „ <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 /> y� facilities for pesticides or emptied containers and equipment used or to be usec <br /> in the treatment . [Form PR-ENF-125 (Rev . 07,92 ) Pesticide Enforcement Branah] <br /> r Permit Applicant : l/ 1 P��D r �O 'lQF I Sign : <br /> Title : =QTM,MLn `/' Issue Date . 6 — <br /> Issuing Officer : / CG�- G. XLH- Issue nate : _ <br /> Page 1 <br /> v. <br /> L <br />