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RESTRICTED MATERIALS PERMIT cont. Page 3 <br /> BELLA VISTA FARMS Permit #: 39-97-3902017 <br /> L WORKERS SAFETY SERIES ATTACHED <br /> ------ ----- ---------- --...- --- --- <br /> [X] A-1 through A--9 General Info. <br /> --_- ; - [� -B-1--Cholinesterase Testing <br /> - - -- - - - -- - - - - - - - - - -- - - -- - - - - - - - - -- - - - - - - -- -- -- - -- - - - - - - <br /> PERMIT CONDITIONS ATTACFtED====--_-____-________-_ <br /> [X] P General <br /> L [X] 9 - Dicamba & Phenoxy Herbicides - Central Valley/hlazardous Area <br /> [� R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) - Sprinkler Irrigation Application <br /> [1 T - Aldicarb (Temik) <br /> [_] U - Endosulfan (Thiodan) <br /> [ I V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> ! [ I Attachments 1-9`. Molinate (1 ,6) thiobencarb (2,6,7) , carbofuran <br /> ` (3,6) , methylparathior, (4,9) and malathion (voluntary. 5, 8) <br /> [� W Methyl Bromide <br /> ( [ I Soil within greenhouses <br /> [_j Commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> L [_] Single tree site <br /> [� X - Furadan chemigation . of grapes <br /> [_] Z - Other <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> L--- - <br /> ----------------------------------- - --- --- <br /> ---- - -- - - - -- <br /> [ The material I am purchasing will not be used in a Pesticide Management <br /> L Zone (as described in Section 6802, Title 3 , California Code of Reg- <br /> ulations) for agricultural , outdoor institutional or outdoor- industrial <br /> use. <br /> L [� 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 /> LMaterial 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 /> L 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 /> then co mis - " ai . <br /> L <br /> char r Date <br /> .L <br /> L <br />