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RESTRICTED MATERIALS PERMIT continued . . . . . Page#: 4 <br /> -GOTTA VINEYARDS, JOE A ` Permit#: 39-03-3400525 <br /> -------------------------------------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------ <br /> [X] A-1 through A-9 General Info. [_I B-1 Cholinesterase Testing <br /> ------------------------------------------------- <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------ <br /> .[X] P - General <br /> [_1 0 - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_I R - Dicamba & Phenoxys - Special Hazardous Area <br /> `[_] S - Metam Sodium (Vapam) <br /> [_] T - Aldicarb (Temik ) <br /> [_] U - Endosulfan ( Thiodan ) <br /> [-] V - Rice Pesticides Program <br /> [_I Molinate (Ordram) Worker Safety <br /> (_] Attachments 1-9: Molinate ( 1 ,6) thiobencarb (2, 6,7 ) , carbofuran <br /> (3,6) , methylparathion (4,9) and malathion (voluntary : 5,8) <br /> _[_I W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> [_] Commodity <br /> [-] Soil injection <br /> [_] Tarped potting soil <br /> C_] Single tree site <br /> [_] X - Furadan chemigation of grapes <br /> —[X] Z - Other <br /> ----------------------------- <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ------------------------------------------------------------------------------- <br /> C_] The material I am purchasing will not be used in a Pesticide Management <br /> Zone (as described in Section 6602, Title 3, California Code of Reg- <br /> ulations) for agricultural , outdoor institutional or outdoor industrial <br /> use. <br /> .[_1 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 [_] Bromacil <br /> [_] 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 /> _ there is no commissioner. <br /> - ---------- -- --z-cl--,/-- <br /> Purchaser Date <br />