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"RESTRICTED MATERIALS PERMISO"continued Page# : 5 <br /> 3RUWELL & MICHELOTTI Permit# : 39-99-3900196 <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------- ----------------------------------------- <br /> [X] A-1 through A-9 General Info. [_] B-1 Cholinesterase Testing <br /> ______________________________________________________________________________ <br /> PERMIT CONDITIONS ATTACHED <br /> ----- ----- ------------- <br /> ---- --- - ------------ <br /> [X] P - General <br /> ` [X] Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> (_] S - Metam Sodium (Vapam) <br /> [_] T - Aldicarb (Temik) <br /> 6. [_] U - Endosulfan (Thiodan) <br /> [_] V - Rice Pesticides Program <br /> [ ] Molinate (Ordram) Worker Safety <br /> L [_] Attachments 1-9 : Molinate (1, 6) thiobencarb (2 , 6, 7) , carbofuran <br /> (3 , 6) , methylparathion (4, 9) and malathion (voluntary: 5, 8) <br /> [_] W - Methyl Bromide <br /> r [ ] Soil within greenhouses <br /> [_] Commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> [ ] Single tree site <br /> [_] X - Furadan chemigation of grapes <br /> [ ] Z - Other <br /> ------------------------------------------------------------------------------- <br /> PESTICIDE SALES : GROUNDWATER PROTECTION <br /> ------------------------------------- ------- ------------ <br /> [_] 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 be 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 /> ., 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 is no commissioner. <br /> ------------- - - -- --------- ------------------ <br /> Purchaser Date <br />