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3ESTRICTED MATERIALS PERMIT continued . . . . . Page#: 5 <br /> 6RUWELL & MICHELOTTI Permit#: 39-00-3900196 <br /> ------------------------------------------------------------------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> ' ------------------------------------------------------------------------------- <br /> CX] A-1 through A-9 General Info. C_] B-1 Cholinesterase Testing <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> - -- ---------------------------------- - <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> ` [X] P -- General <br /> [ X] 0 - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) <br /> [_7 T -- Aldicarb (Temik ) <br /> [_] U - Endosul.fan (Thiodan) <br /> r, [_] V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> C_] Attachments 1-9: Molinate (1,6) thiobencarb (2,6,7) , carbofuran <br /> (3,6) , methylparathion (4,9) and malathion (voluntary: 5,S) <br /> ` C_] W - Methyl Bromide <br /> C-7 Soil within greenhouses <br /> [_] Commodity <br /> Soil injection <br /> [_] Tarped potting soil <br /> [_] Single tree site <br /> W. [_] X - Furadan chemigation of grapes <br /> C ] 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 C_] Bromacil <br /> C_] Diuron [_] Prometon C_] 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 /> th a is no commissioner. <br /> Purchaser Date <br />