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I <br /> 1' Rea't.rict.ed Materials Permit Conditions Page#: 1 0£ 3 <br /> The Following Conditions Apply To . . . . . . . . . . . . . . . . . . . . . . Permit#: 39-03-3900391 <br /> -- -------------------------------------------------------------------- -- <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------ <br /> [X] A-1 through A-9 General Info. ; (_] B-1 Cholinesterase Testing <br /> ------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------- <br /> 6 PERMIT CONDITIONS ATTACHED <br /> --------- ---------------- ------- -- -------------------------------------------------------- <br /> [X) P - General <br /> L [X] a - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> R - Dicamba & Phenoxys - Special Hazardous Area <br /> S Metam Sodium & Metam Potasai.tur <br /> [_] T - Aldicarb (Temik) <br /> U - Endosul.fan (Thiodan) <br /> L [_] V - Rice Pesticides Prngram <br /> [_] Molinate (Ordram) Worker Sefety <br /> [_] Attachments 1-9: Molinate (1 ,6) thiobencarb (2,6,7) , carbofuran <br /> (3,6) , methylparathion (4,9) and malathion (voluntary: 5,8) <br /> L [_] W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> [_] Commodity <br /> r_] Soil injection <br /> [_] Tarped "potting soil <br /> [_] Single tree site <br /> [_] X - Furadan chemigation of grapes <br /> [_) Z - Other <br /> -------------------------------------------------------------------------------- <br /> -------------------------- <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> _ I_ _ <br /> [R!�j_.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 /> [_] The material I am purchasing will he used in a Pesticide Management Zone <br /> (as described in Section 6802, Title 3, 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 [_] Simazine [_] Bromacil <br /> [_] Diuron [_] Prometon [_] Bentazon <br /> y. 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 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 i`-s�n-o�co(mmissio er. <br /> - <br /> Purchaser Date <br /> a <br />