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SAN JOAQUIN COUNTY <br /> 1868 E. HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> 09) 468-3300 Recorder (NOI) : (209) 468-3300 FAX: (209) 468-3330 <br /> ACTED MATERIALS 'PERMIT Permit# : 39-99-3900391 <br /> County HQ District#: H <br /> ^7LLERI VICTOR Expiration Date : 12/31/1999 <br /> L13 E MAIN ST Effective Date : 01/04/1999 <br /> STOCKTON, CA 95205 <br /> CCTOR ROLLERI Home: (209) 463-8466 <br /> s.L13 E MAIN ST Shop: ( ) - <br /> STOCKTON, CA 95205 Fax: <br /> Mobile : <br /> Permittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> ^ivate App [X] Seasonal [X] Poss & Use [X] Phone (X] Fax (X] <br /> Q' A Cert ( ] Job [ ] Poss Only [ ] Box (X] Modem [ ] <br /> Ag PCO ( ] In Person [X] <br /> :)n-Ag [ ] NOI required 24 hours prior to application <br /> Numb Pesticide Pest (s) Form. Method (s) Applicator (s) <br /> ---- -------------- - ------------ --------- ---------------- ----------------- <br /> )51 SEVIN LARVAE Liquid Ground PCO Grower <br /> 1591 THIODAN LARVAE Liquid Ground PCO Grower <br /> 3141 GUTHION MITES Liquid Ground PCO Grower <br /> 330 METHOMYL LARVAE Liquid Ground PCO Grower <br /> x6971 MONITOR LARVAE Liquid Ground PCO Grower <br /> 99999 NON-PERMIT AG P WEEDS Liquid Ground PCO Grower <br /> Mbn-Ag Use : <br /> Conditions : PU <br /> I understand that this permit does not relieve me from liability for any damage <br /> D persons or property caused by the use of these pesticides . I waive any <br /> laim of liability for damages against the County Department of Agriculture <br /> Lased on the issuance of this permit . I further understand that this permit <br /> -ay be revoked when pesticides are used in conflict with the manufacturer ' s <br /> abeling 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 /> Runty Department of Agriculture of all areas treated or to be treated, storage <br /> ..acilities for pesticides or emptied containers and equipment used or to be used <br /> in the treatment . (Form PR-ENF-125 (Rev. 07/92) Pesticide Enforcement Branch] <br /> =_rmit Applicant : Sign: <br /> Title: Date : <br /> —Issuing Officer: Date: <br /> ARE AB E 0 LOCATE SIGNED ORIGINAL 1999 PERMIT. <br /> HAZ R. GALLL �FFICE ASSISTANT SPECIALIST <br />