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r DEPARTMENT OF PESTICIDE REGULATION <br /> PESTICIDE ENFORCEMENT BRANCH <br /> S TEOFCALIFORNIA <br /> ¢NATE APPLICATOR <br /> CERTIFICAMN STAT EBMIE IT CERTIFICATION EXPIRATION DATE <br /> F _NF.172(EST.7i91) _ <br /> APPLICATOR PHONE N MBER <br /> PRIVATE APPLICATOR NAME <br /> t.- t= ,• �J ;r <br /> .-)PESS <br /> PERMIT NUMBER ISSUED COUNTY PHONE NUMBER <br /> ;TIFnNG COUNTY N `E . 3 _ !3 <br /> 'T SUED .- D? d TITLE J <br /> CEPTIFICATIOWPERMITZSSUED <br /> t <br /> RTIFICA nON ISSUED: <br /> © <br /> GENERAL EXAMINATION WORKER FETY EXAMINATION <br /> LSTICIDE SAFETY SEPIES INFORMATION PROVIDED; PESTICIDE SAFETY SERIES INFORMATION[SERIES NUMBE (S)PROVIDED]: <br /> YES NO <br /> Lcertify the above information is correct and that 1 have taken the Private Applicator Certification examination for the possession <br /> and/or use of restricted use pesticides. I have reviewed and understand questions answered incorrectly with the issuing county. <br /> DATE SIGNEDICERTIRED <br /> :RTIFIEDP LI ATORgkGNATURr•" <br /> . f2 2 <br /> Pink —Copy <br /> Disvlbutim <br /> on mnal—County 17 Canary—Certified Private Applicator <br /> L <br /> L <br /> V <br /> r. <br />