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SAN JOAQUIN COUNTY <br /> ` 1868 E. HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Office: (209)468-3300 Recorder (NOI): (209)468-3300 :x'09)468- --;30 <br /> STRICTEU MP.TERIALS PERMITPermit 39-01 399--IM , <br /> County HQ Dist- C <br /> N$A Fr 3 Ex�i ion L)ate . 12/3120()1 <br /> P 0 BOX 235 Effective Da£e <br /> ,SCALON, CA 95320-0235 <br /> O ERMAN DOORNENBAL Home: (209)838-1122 <br /> 27282 LONE TREE RD Shop: (1PGR)995-1572 <br /> ;SCALON, CA 95320- Fax: <br /> Mobile: (209)401-5063 <br /> -'ermittee Type Permit Type Possession NOI Method of Submission <br /> ------------- ------------ -------------- -------------------------- <br /> 6. <br /> Private App [X1 Seasonal [X] Poss & Use CX] Phone [X1 Fax [X] <br /> r' A Cert C 7 Job C ] Poss Only C 7 Box CX] Modem CX] <br /> g PCO C ] In Person [XI <br /> mon-Ag [ ] NOI required 24 hours prior to application <br /> ------------------------------------------------------------------------------- <br /> umb Pesticide Pest(s) Form. Method(s) Applicator(s) <br /> ..---- --------------- ------------ -------- ---------------- ---------------- <br /> 200 AMITROLE WEEDS Liquid Ground PCO Grower <br /> 051 SEVIN LARVAE Liquid Air Ground PCO Grower <br /> X000 DICAMBA WEEDS Liquid Air Ground PCO Grower <br /> 3330 METHOMYL LARVAE Liquid Air Ground PCO Grower <br /> '1940 METHYL PARATHIO LARVAE Liquid Air Ground PCO Grower <br /> 491 ORDRAM WEEDS Granules Air Ground PCO Grower <br /> '4840 ALUMINUM PHOSPH RODENTS Fumigant Ground PCO Grower <br /> 5030 PROPANIL WEEDS Liquid Air Ground PCO Grower <br /> 860 MCPA, DIMETHYLA WEEDS Liquid Air Ground PCG Grower <br /> .801 2,4-D AMINE WEEDS Liquid Air Grouru3 PCO Grower <br /> ****** PESTICIDES CONTINUED ON NEXT PAGE ***� <br /> -on-Ag .Use: <br /> onditions: PQVZ <br /> --------------- ------ <br /> understand that this permit does not relieve me from liability for any damage <br /> 'ro persons or property caused by the use of these pesticides. I waive any <br /> clain: of liability for damages against the County Department of Agriculture <br /> ased on the issuance of this permit. I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacture.r'r-1 <br /> labeling or in violation of applicable laws, regulations and specific <br /> onditions of this permit_ I authorize inspection at all reasonable times and <br /> henever an emergency exists, by the Department of Pesticide Regulation or the <br /> !cunty 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 /> the treatment. [Form PR-ENF-125 (Rev. 07/92) Pesticide Enforcement Branch]] <br /> Permit. Applicant: H2 <br /> 'r --DOD <br /> nA0"-4;1 <br /> L, Title: Date: <br /> LIssuing Officer: Uate: <br /> L <br />