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� <br /> � <br /> JOTY <br /> U 1868 E. AZELTON AVENUE: <br /> * ' ��T�CKTON, �A 95205 <br /> ficer ( 09 )468-3300 Recorder (NOI > : (209)468-3300 FAX ; (209)46G-333(| <br /> ERIALS PERMIT <br /> County HQ District# : D <br /> xp��arl On � <br /> 282 RIED 1Effective Date <br /> FNDEN, <br /> D FORD Home: (209 )938-�448 <br /> 2 F�IED � S�op: (209)946-0315 <br /> � JNDEN, C�\ 95236 Fax : <br /> ' Mobile : <br />| � <br /> rM.ittee� TyPe Permit Type Pion ` NOI Method of Bubmission <br /> V ^-------- ---- ------------ -------------- -------------------------- <br /> Private A�p [X] Seasona1 [X] Poss & Use [X] . Phone [X] Fax [X] <br />| A Cert � [ ] Jnb [ ] Poss Only [ ] Bsx [X] Mode� [X] <br />| <br /> �Von-Ag � [ ] N'01, required 24 hours p�ior� to application <br /> i � -mb Pes�icide Pest(s) Form Method ( M) App� icator(s) <br /> X '___ ---- ^--- ----------- --- ----------------- <br /> 13'0 CHL ROPICRIN SOIL PEST Fumigant Ground Grower <br />| 41 GUT � IN LARVAE AlI Reg Air Ground PcD Grcw�r <br /> U �350 ME J6 vi BR8��DE SOIL PEST Fumigant Ground 8rower ' <br /> 39�� PENNCAP LARVAE Liqu�d r- PC� Grower <br /> 1 2, 4�D AMINE WEED8 Liquid Ground Grower <br /> � 6011 Lid- J23round- <br /> �i891 LARV>�E Liquid Air Ground PCQ Grower <br /> U --�- '--------'----'---- ---------- ------' -' - <br /> ° ^ <br /> Ffn-A� <br /> .nditioo <br /> � <br /> =======� == <br /> � underst�nd that this �ermit does not relieve me from liability for any damage <br /> person or property caused by theuse of these pesticides. I waive any <br /> Iaim of �iability for damages against the County Department of AgricuIture <br /> Fsed om �he issuance o� this permit. I f er undCrstand that this permit <br /> ay be re--ok�� when pesticides are usedin conflict with tmanufacturer' s <br /> IabeIing �r i� vioIation of applica�le Iaw�, regulations and specific <br /> ditions of this permit. I authorize inspection at alI reasonable times and <br /> --ver �n emergency existsr by the Departuuent of Pesticide Re�uIation orth� <br /> C y De ' artment of Agricul ture of al l ar«sas treated or to be treated , storage <br /> p t i i di ti d t a i n e r z,n.d e q ui p n t d nr to be used <br />