Laserfiche WebLink
i <br /> SAN JOAQUIN COUNTYQryZ <br /> 1868 E . ON AVENUE <br /> STOCKTON,ON. CACA 95205 <br /> Web URL :www. co . san-joaquin . ca. us/agcomm <br /> E-Mail : <br /> Office : ( 209 ) 468-3300 Recorder (NOI ) : ( 209 ) 468-3300 FAX: ( 209 ) 468-3330 <br /> ______________________________________________ <br /> RESTRICTED MATERIALS PERMIT PERMIT # : 39-02-3903073 <br /> County HQ District # : C <br /> r <br /> DOORNENBAL, HERMAN Expiration Date: 12/3112002 <br /> P O BOX 235 Effective Date <br /> _ ESCALON, CA 95320-0235 <br /> HERMAN DOORNENBAL Home: ( 209) 838-1122 <br /> 27282 LONE TREE RD Shop : <br /> ESCALON, CA 95320- Fax: <br /> Mobile : 2096140872 <br /> -------------------------------------- <br /> ---------------------------------- <br /> ' armittee Type Permit Type Possession NOI Method of submission <br /> ------------- ------------ -------------- -------------------------- <br /> bPrivate App IXI Seasonal IXI Poss & Use IXI PhoneIXI Fax IY.I <br /> P A Cert 1 1 Job 1 1 Poss Only 1 1 Box IXI Modem I I <br /> 3 PCO I I In Person IXI Web IXI <br /> an-Ag I -----------------------NOI-required-24-hours-prior-to application <br /> Dn-Ag Use : None <br /> bonditions : PQVZ <br /> 4�- 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 /> - laim of liability for damages against the County Department of Agriculture <br /> 3sed on the issuance of this permit . I further understand that this permit <br /> Way be revoked when pesticides are used in conflict with the manufacturer's <br /> labeling or in violation of applicable laws, regulations and specific <br /> -Dnditions of this permit . I authorize inspection at all reasonable times and <br /> ❑enever an emergency exists, by the Department of Pesticide Regulation or the <br /> tounty 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 /> -n the treatment . [Form PR-ENF-125 (Rev. 07/92 ) Pesticide Enforcement Branch] <br /> Permit Applicar* • Sign: 'i{€VlMY11� AcwdlpVl�l1' <br /> Title : -n nne '�. ` Issue Date : C-, - o'Z <br /> �A�� 2 <br /> Issuing Officer : Issue Date : <br /> � __ '-Y�-q 2— <br /> Page <br /> Page 1 <br /> r <br /> r <br />