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SAN JOAQUIN COUNTY <br /> 1868 E . HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Web URL www . co . san-joaquin . ca . us/agc E-mail <br /> Office ( 209 ) 468-3300 Recorder (NOI ) ( 209 ) 468-3300 FAX ( 209) 468-3330 <br /> RESTRICTED MATERIALS PERMIT PERMIT # : 39-04-3900233 <br /> County HQ District # : D <br /> LAGORIO, JAMES Expiration Date : 12/31/2004 <br /> 155 N DUNCAN Effective Date : -61/0177'1.999 <br /> LINDEN, CA 95236- <br /> JAMES LAGORIO Home : ( 209 ) 463-707(3 <br /> 155 N DUNCAN Shop : ( ) - <br /> LINDEN, CA 95236- Fax: <br /> Mobile <br /> Permittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> Private App IXI Seasonal IXI Pose & Use IXI Phone IXI Fax I <br /> Q A Cert I I Job 1 1 Pose Only 1 1 Box IXI Modem I I <br /> Ag PCO I I In Person IXI Web I I <br /> Non-Ag I I NOI required 24 hours prior to application <br /> Non-Ag Use : None <br /> Conditions : Q,W,P QAL LIC #38036 , QAL LIC #38037 <br /> I understand that this permit does not relieve me from liability for any damage <br /> to persons or property caused by the use of these pesticides . I waive any <br /> claim of liability for damages against the County Department of Agriculture <br /> based on the issuance of this permit . I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacturer ' s <br /> labeling or in violation of applicable laws, regulations and specific <br /> conditions of this permit . I authorize inspection at all reasonable times and <br /> whenever an emergency exists , by the Department of Pesticide Regulation or the <br /> County Department of Agriculture of all areas treated or to be treated, storage <br /> facilities for pesticides or emptied containers and equipment used or to be used <br /> in the treatment . [Form PR <br /> e-ENF-125 (Rev. 07/92 ) Pesticide Enforcement Branch] <br /> Permit Applicant : Q^r R• 4a o• Sign : <br /> Title : 1 °� Issue Date : 2- <br /> Issuing Officer : Issue Date : <br /> r Page I <br />