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\. ..� 2003 ✓ <br /> ` SAN JOAQUIN COUNTY <br /> 1868 E . HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Web URL :www. co . san-joaquin . ca , us.�agcomm <br /> i' E-Mail . <br /> Office : ( 209) 468--3300 Recorder (NOI ) : ( 209 ) 458--3300 FAX. ( 209 ) 468-3330 <br /> L RESTRICTED MATERIALS PERMIT PERMIT u 39-03-3900391 <br /> County HQ District u . H <br /> L ROLLER! , VICTOR Expiration Date . 12:'31.•200: <br /> 5:13 E MAIN ST Effective Date . ?}-1@T."r7T <br /> L sTOCKTON. CA 95205 <br /> 3/x/0 3 <br /> VICTOR ROLLERS Home . t209 ) 463-a486 <br /> 5113 E MAIN ST Shop : ( ) -- <br /> STOCKTON. CA 95205 Fax : <br /> r Mobile ( ) <br /> V <br /> Permittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> Private App IXI Seasonal IXI Pose & Use 1XI Phone IXI Fax IXI <br /> �. Q A Cert I ! Job I I Poss Only I I Box 1 I Modem JXI <br /> Ag PCO I I In Person JXI Web IXI <br /> Non-Ag I I NOI required 24 hours prior to application <br /> L <br /> Non-Ag Use . None <br /> LConditions : PQ <br /> I under--t inn '. I-:"O :ex:nit me irual iiabiliLy ivs any darneyN <br /> L, 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 timed 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 /> L 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 Bran- J <br /> 77 , t i <br /> ` Permit Applicant : �[j ��D k �r? 'l�(� I Sign : <br /> Title : amJYtgo/ Issue Date . <br /> r <br /> Issuing Officer : ! �� �° �/ y' `� Issue Date <br /> Page 1 <br /> r <br /> L <br />