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i DEPARTMENT OF PEST( -REGULATION <br /> STATE OF CALIk ,MA ENFO TIENT 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 /> OPERA R(FIRM NAME) ADDRESS CITY ZIP CODE PHONE NUMBER <br /> Af; <br /> OPERAT ID/PERMIT UMBER LICENSE NUMBER COUNTY WHERE APPLIED D7, <br /> UNTY NUMBER MONTH/YEAR OF USE TOTAL NUMBER OF APPLICATIONS <br /> 1.Complete Columns A,B, C,and D for All Use <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 C D E F <br /> CODE COMMODITY OR SITE ACRES/UNITS <br /> MANUFACTURER AND EPA/CALIFORNIAINEGISTCLUDE REGALPISTRATION <br /> COMBER FROM LABEL (Circle TOAL One <br /> CT of measure) APPLICATIONS <br /> TREATED TREATED <br /> NAME OF PRODUCT APPLIED <br /> .� i� c c.r a� 6 <br /> LBj <br /> ./1 L (� OZ PT QT GA 49,, <br /> �C — <br /> �' <br /> LB OZ PT QT GA <br /> r i�,Lq a �� <br /> -3 / O 5 tom© LB ,0P,T QT GA <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA r r <br /> e: <br /> LB OZ PT OT GA ° <br /> �t9 a <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 /> DATE / L <br /> REPORT PREPARED BY <br />