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STATE OF CAJ JIA DEPARTMENT OF PEST 7 REGULATION <br /> ENFO HENT BRANCH <br /> MONTHLY SUMMARY PESTICIDE USE REPORT <br /> PR-ENF-060(REV.08/08)Page 1 of 6 <br /> INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW AND ON THE REVERSE SIDE <br /> CITY ZIP CODE PHONE NUMBER <br /> OPERAT ,(FIRM NAME ADDRESS `^ /` /'� 012 / VO-)) 0 <br /> VTI 4�OPERATOR ID/PERMIT NUMBER LICENSE NUMBER COUNTY WHERE APPLIED COUNTS NUMBER MONTH YEAR FUSE TOTAL NUMBER OF APPLICATIONS <br /> t.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 Ilnes,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 not fit one of the above codes <br /> A B C p E F 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 GA <br /> �- LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA P� <br /> LB OZ PT QT GA S <br /> r*, <br /> m i <br /> J <br /> l <br /> LB OZ PT QT GA `t t`'•r G <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA / <br /> REPORT PREPARED BY DATE �- `� <br />