Laserfiche WebLink
A ( DEPARTMENT OF PESTIS] -REGULATION <br /> STATE OF CALI <br /> ENFO ENT BRANCH <br /> MONTHLY SUMMARY PESTICIDE USE REPORT <br /> PR-ENF-060(REV.08/08)Page 1 of 6 ZV L <br /> INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW AND ON THE REVERSE SIDE <br /> OPERATOR(FIRM NAME) ADDRESS CITY ZIP CODE PHONE NUMBER <br /> 4. f—'7 <br /> OPERATOR IDIPERMIT NUMBER LICENSE NUMBER COUNT HE E A PLIED COUNTY NUMBER MONTH/YEAR OF USE TOTAL NUMBER OF APPLICATIONS <br /> -2,(M L4 I'C <br /> 1.Complete Columns A,B,C,and D for All Users <br /> 2. Complete Column E by using one of the following codes: <br /> Code 10 Structural Pest Control.....................................includes any pest control work performed within or on buildings and other structures. <br /> Code 30 - Landscape Maintenance Pest Control.............Includes any pest control work performed on landscape plantings around residences or other buildings,golf courses,parks,cemeteries,etc. <br /> Code 40 Right-of-Way Pest Control...............................Includes any pest control work performed along roadsides,power lines,median strips,ditch banks,and similar sites. <br /> Code 50 Public Health Pest Control...............................includes any pest control work performed by or under contract with State or local public health or vector control agencies. <br /> Code 80 Vertebrate Pest Control....................................includes any vertebrate pest control work performed by public agencies or work under the supervision of the State or county agricultural commissioner. <br /> Code 91 - Commodity Fumigation(Nonfood/Nonfeed).....includes fumigation of nonfood/nonfeed commodities such as pallets,dunnage,furniture,burlap bags,etc. <br /> Code 100 Regulatory Pest Control.................................includes any pest control work performed by public employees or contractors in the control of regulated pests. <br /> 3. Complete Columns F and G,if use does nQ. fit one of the above codes <br /> A B � O E P G <br /> MANUFACTURER AND EPA/CALIFORNIA REGISTRATION NUMBER FROM LABEL TOTAL PRODUCT USED NUMBER OF CODE COMMODITY OR SITE ACRES/UNITS <br /> NAME OF PRODUCT APPLIED INCLUDE ALPHA CODE (Circle One Unit of Measure) APPLICATIONS TREATED TREATED <br /> LB OZ PT QT GA <br /> LB OZ PT QT CGA _ t' .... <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> rJ <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA SY4t` 61C.GvIV%tvi - <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA j <br /> REPORT PREPARED BY DATE <br />