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STATE OF CHLIFL.,JIA DEPARTMENT OF PEST REGULATION <br /> ENFO .✓LENT BRANCH <br /> MONTHLY SUMMARY PESTICIDE USE REPORT <br /> PR-ENF-060(REV.08108)Page 1 of 6 <br /> INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW AND ON THE REVERSE SIDE <br /> OPER TOR(FIRM NAME) ADDRESS Cl ZIP CODE PHONE NUMBER <br /> -79-6 ,,,v :7 —,C L <br /> OPERAT ID/PERMITNUMBER LICENSE NUMBER OU Y WHERE APPLIE COUNTY NUMB MONTH YEAR OF USE TOTAL NUMBER F APPLICATIONS <br /> 3W e- <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 fit one of the above codes G <br /> A B C p E F <br /> COMMODITY OR SITE ACRES/UNITS <br /> MANUFACTURER AND EPA/CALIFORNIA <br /> INCLUDEA PHA COMNUMBER FROM LABEL (Circle TOTAL PRODUCT <br /> One Unit of USE e) ANUMBERIONS OF CODE TREATED TREATED <br /> NAME OF PRODUCT APPLIED <br /> S <br /> 160 <br /> ati cx V✓ /j� L OZ PT QT GA <br /> LB OZ PT Q GA <br /> Chcm�nf0Ll'CA- h V0 <br /> C, <br /> LB OZ PT le'Q—n GA <br /> LB OZ PT QT GA e <br /> .rr i e <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 <br /> LB OZ PT QT GA r <br /> REPORT PREPARED BY DATE <br />