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0 <br /> 04 SAN JOAQUIN COUNTY <br /> 1868 E. HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> lbf£ice: (209)468-3300 Recorder (NOI ) : (209)468-3300 FAX: (209)468-3330 <br /> V I STRICTED MATERIALS PERMIT Permit#: 39-01-3902066 <br /> County HQ District#: J <br /> (ORNASERO, TOM Expiration Date: 12/31/2001 <br /> 681 W LINNE RD Effective Date : 01/08/2001 <br /> RACY, CA 95376- <br /> ,�OM FORNASERO Home: (209)835-2997 <br /> V681 W LINNE RD Shop: ( ) - <br /> fRACY, CA 95376- Fax: 832-2370 <br /> Mobile: <br /> - - - -- - --- - - <br /> If <br /> ------------------------------------------------------------------------------ <br /> ermittee Type Permit Type Possession NOI Method of Submission <br /> ------------- ------------ -------------- -------------------------- <br /> jPrivate App [X] Seasonal [X] Poss & Use CX] Phone [X] Fax CX] <br /> A Cert C ] Job C ] Poss Only C ] Box 1X7 Modem C ] <br /> g PCO C ] In Person [X] <br /> b7on-Ag C ] NOI required 24 hours prior to application <br /> ----------- ----------------------------------------------------------------- <br /> ----------------------------------------------------------------- <br /> tumb Pesticide Pest(s) Form. Method(s) Applicator(s) <br /> l----- --------------- ------------ -------- ---------------- ----------------- <br /> b1360 CHLOROPICRIN NEMATODE Fumigant Fumigate PCO Grower <br /> 3141 GUTHION MITES Liquid Air Ground PCO Grower <br /> 03824 METASYSTOX-R APHID Liquid Air Ground PCO Grower <br /> C850 METHYL BROMIDE SOIL/STORED Fumigant Fumigate PCO Grower <br /> 940 METHYL PARATHIO LARVAE Liquid Air Ground PCO Grower <br /> 1840 ALUMINUM PHOSPH RODENTS Fumigant Ground PCO Grower <br /> IP801 2,4-D AMINE WEEDS Liquid Ground PCO Grower <br /> 16011 PARAQUAT WEEDS Liquid Ground PCO Grower <br /> ,16891 SUPRACIDE LARVAE Liquid Air Ground PCO Grower <br /> Con-Ag Use: <br /> oponditions: PQWZ <br /> --- - - -- - - - - - <br /> ----- ------------------------------------------------- <br /> I,I understand that this permit does not relieve me from liability for any damage <br /> tpersons or property caused by the use of these pesticides. I waive any <br /> klaim of liability for damages against the County Department of Agriculture <br /> epased on the issuance of this permit. I further understand that this permit <br /> Cay be revoked when pesticides are used in conflict with the manufacturer's <br /> labeling or in violation of applicable laws, regulations and specific <br /> Oponditions 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 use <br /> ,in the treatment. [Form PR-ENF-125 (Rev. 07/92) Pesticide Enforcement Branch] <br /> ,Permit Applicant: Oat, ��i('�N{ r(7 Sign: X144a. •� <br /> Title: ,A A,Ylg l Date: 1—%- 01 <br /> Issuing Officer: /^ Date : <br /> 1 <br />