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STATE OF CAJ JIA If DEPARTMENT OF PEST REGULATION <br /> 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 /> OPE TOR(FIRM NAME) ADDRESS CITY ZIP CODE PHONE NUMBER <br /> OF U�-2 2 G <br /> OPERATOR ID/PERMIT NUM R LICENSE NUMBER COU TY WHERE APPLIED COUNTY NUMBER MONTHIYEAR USE TOTAL NUM APPLICATIONS <br /> a <br /> 1.Complete Columns A,B, C,and D for All User$ <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 not fit one of the above codes <br /> E F G <br /> A B C p <br /> CODE COMMODITY OR SITE ACRES/UNITS <br /> MANUFACTURER AND EPA/CALIFORNIAINEGIST REGISTRATION <br /> CONUMBER FROM LABEL DE (Circle TOTALPRODUCT <br /> Unit of Measure)e) APPLICATIONS TREATED TREATED <br /> NAME OF PRODUCT APPLIED <br /> 730 �2, <br /> S r L OZ PT QT GA <br /> C-1 —Z— <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA y "F` :.a�& <br /> LB OZ PT QT GA ?' r 221 <br /> .�r9. I N CDFCU TY <br /> Ae <br /> LB OZ PT QT GA r <br /> 07 <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> DATE C <br /> REPORT PREPARED BY �'J a <br /> r <br />