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STATE OF CALIF IIA r DEPARTMENT OF PEST/ -REGULATION <br /> MONTHLY SUMMARY PESTICIDE USE REPORT / ENF .AENTBRANCH <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 /> OPERA OR(FIRM NAME) ADDRESS -� CITY f ZIP CODE PHONE NUMBER <br /> i'' -C C.,�-� 1-NIZ-5 -�,_ / c`° L � c1 .�Vii <br /> OPERATOR ID/PERMIT NUMBER LICENS NUMBER COUNTY WHERE APPLIED COUNTY NUMBER MONTH/YEAR OF USE TOTAL NUMBER OF APPLICATIONS <br /> 1.Complete Columns A,B, C,and D for All Uw-s <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 /> A B C D 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 /> f�mL. � 2 <br /> pre) _ � r /0 J <br /> 7 LB O QT GA I C �_. <br /> 00~^ C57? LB OZ PT QT GA <br /> t r <br /> LB OZ PT QT.,,'�GA <br /> � C <br /> LI LB OZ <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> � L I <br /> \� g <br /> LB OZ PT QT GASAO. O- A <br /> 1"l1 11A •:,;f it 3tti1r i <br /> LB OZ PT QT GA °itC "G '" LOD, <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> REPORT PREPARED BY DATE ��_ <br />