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SAN JOAQUIN COUNTY <br /> 2003 <br /> 1868 E. HAZELTON AVENUE <br /> STOCKTON. CA 95205 <br /> LWeb URL :www. co . san-joaquin . ce . us/agcomm <br /> E-Mail : <br /> Office : (209 ) 468-3300 Recorder (NOI ) : ( 209 ) 468-3300 FAX : ( 209 ) 468-3330 <br /> County HQ District # : C <br /> DOORI•iENBAL, HERMAN Expiration Date: 12/31/2003 <br /> P O BOX 235 Effective Date =vim <br /> ESCALON, CA 95320-0235 Ol�/�/Zoo3 <br /> I <br /> L <br /> HERMAN DOORNENBAL Home : ( 209 ) 838-1122 <br /> I27282 I.ONdE TREE RD Shop : <br /> ESCALON, CA 95320- Fax: <br /> Mobile : 2096140872 <br /> ---------- <br /> ---------- <br /> L ____________________________________________________________________ <br /> Permittee• Type Permit Type Possession NOT Method of Submission <br /> - --- -- ------------ -------------- ------ <br /> ----- -------------------- <br /> : vats-App- IXI Seasonal IXJ POSE & Use (X� Phone IXI Fax IXI <br /> trA Ce'n't I I Joh I I Paso Only I I Box ;X I Modem I I <br /> Ag PCO I I In Person IXI Web IXI <br /> Ag - I NOT required 24 hours prior to application <br /> LIppin-Aa Use : None <br /> :Inditione : PQV _ <br /> 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 /> -!aim 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 /> "ay be revoked when pesticides are used in conflict with the manufacturer 's <br /> labeling or in violation of applicable laws, regulations and specific <br /> ?editions of this permit . I authorize inspection at all reasonable times and <br /> aenever an emergency exists, by the Department of Pesticide Regulation or the. <br /> Isounty 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 tt?e treatment . [Form PR-ENF-125 (Rev. 07/92 ) Pesticide Enforcement Branch3 <br /> ti <br /> Permit, Applicant : IZw�At3 _DDnVrer[k0W ' _A2 Sign: — <br /> I Title : SJl/aNt~w-L_ Issue Date : � •- 11 - �� <br /> Issuing Officer : <br /> Issue Date : <br /> G page <br /> L <br /> L <br />