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"esVicted Materials Permit Conditions PageQ ) of c <br /> Ito Following Conditions Apply To. . . . . . . . . . . . . . ... . . . . . Permit&1006-3400525 <br /> WORKERS SAFETY SERIFS ATTACHED <br /> ---------------------------------- <br /> ------------------------------------------- <br /> 01 A-1 through A-9 General Info. [_7 B-1 Cholinesterase Testing <br /> r <br /> PERMIT CONDITIONS ATTACHED <br /> i <br /> --------------------------------------------------------------- <br /> ----------`------- <br /> X7 P - General <br /> [_1 O - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> C_1 R - Dicamba & Phenoxys - Special Hazardous Area <br /> L[_] S - Metam Sodium & Metam Potassium <br /> f_7 T - Aldicarb (Temik) <br /> 1 U - Endosulfan (Thiodan) <br /> `[_3 V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> [_7 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 /> C_7 Sail within greenhouses <br /> C_7 Commodity <br /> [_1 Soil injection <br /> [_] Tarped potting toil <br /> [_7 Single tree site <br /> [_7 X - Furadan chemigation of grapes <br /> C_1 Z - Other <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 [_7 Bromacil <br /> [_7 Diuron C_7 Prometon [_7 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 /> o 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 /> A------[_'675w- --------- ---- --- <br /> '� Purchaser Date <br /> r <br />