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STATE OF CALF JA DEPARTMENT OF PEST/ -REGULATION <br /> MONTHLY SUMMARY PESTICIDE USE REPORT ENF MENT BRANCH <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 /> OPE TOR(FIRM NAME) ADDRESS CITY ZIP CODE PHONE NUMBER <br /> --1 / <br /> OPERATOR ID/PERIVflT NUMBER LICENSE NUMBER COUNTY WHERE APPLIED C UNTY NUMB MONTH/YEAR OF USE TOTAL NUMBER OF APPLICATIONS <br /> r <br /> 9 <br /> 1.Complete Columns A,B, C,and D for Al/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 no fit one of the above codes <br /> G <br /> A g C D E F <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 " t � <br /> Ila AL� <br /> L OZ �PT�QTS 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 <br /> IJP <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> LB OZ PT OT GA <br /> REPORT PREPARED BY DATE <br />