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SAN JOAQUIN COUNTY <br /> 1868 R HAZELTON AVENUE <br /> STOCKTON, CA 95205- <br /> E-mail: Web:mvww.co.sac-joaqum.causlagcomm <br /> Office: (209)468.3300 Fax: (209)168.3330 Recorder(NOPs): (209)468.3300 <br /> RES'T'RICTED MATERIALS PERMIT <br /> DOORNENBAL, HERMAN Permit Number; 39-04-3903073 <br /> P 0 BOX 235 County District k C <br /> ESCALON, CA 95320-0235 Expiration Date: December 31,2004 <br /> Effective Date: 4aMWy+'_t990-- <br /> - 3 -1/-0� <br /> HERMAN DOORNENBAL Home Phone: (209)838-1122 <br /> 27282 LONE TREE RD Shop Phone: <br /> ESCALON, CA 95320- Mobile Phone: (209) 614-0872 <br /> Fax: <br /> Permittee Type: Private Applicator NOI Method of Submission <br /> Permit Type: Seasonal Phone: X Fax: X Box X <br /> Possession: Possession &Use In Person: X Modem: Web: X <br /> NOI required 24 hours prior to application. <br /> Conditions: AP,QRICE See and of permit for <br /> code descriptions. <br /> — — — — — — — — — — — — — — — — — — — — — — — — — — — — — <br /> I understand that this permit does not relieve me from liability for any damages to any persons or property caused <br /> by the use of these pesticides. I waive any claims of liability for damages against the County Department of <br /> Agriculture based on the issuance of tivs permit I further understand that this pennit may be revoked when <br /> pesticides are used in conflict with the manufacturers labeling or in violation of applicable laws,regulations mid <br /> specific conditions of this permit I authorize inspection at all reasonable times and whenever an emergency exists <br /> by the Department of Pesticide Regulation or the County Deportment of Agriculture of all areas treated or to be <br /> treated,storage facilities for pesticides or emptied containers and equipment used or to be used in the treatment <br /> _ [FoYn PR-ENF-125 (Rev. 07/92)Pesticide Enforcement Branch 1 <br /> j <br /> Permit Applicant "y�t�11�i \�o�vti1�•�b ca � Signed �,���-e✓� <br /> pp P sse Front) <br /> \ <br /> Title: �_o Issue Date: <br /> (Ptease Pno4� <br /> n Issuing Officer- Issue Date: v <br />