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r DEPARTMENT OF PEST 'REGULATION <br /> STATE OF CALIFS..JIA ENFO RENT BRANCH <br /> MONTHLY SUMMARY PESTICIDE USE REPORT t <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 /> OPERATOR ID/PERMIT NUMBER LICENSE NUMBER COUNTY WHERE APPLIED COUNTY NUMBER MONT�EAR OF USE TOTAL NUMBER OF APPLICATIONS <br /> r <br /> 1.Complete Columns A,B,C,and D for All Users <br /> 2. Complete Column E by using one of the following codes: <br /> Code 10 Structural Pest Control...............................I.....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......................I........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 G <br /> A B C D E F <br /> COMMODITY OR SITE <br /> /CACRES/UNITS <br /> MANUFACTURER AND INCLUDE REGISTRATION <br /> ALPHAATION CODE NUMBER FROM LABEL (Circle TOTAL <br /> e UOnDt of USED <br /> SE e) APPLICATIONS NUBER OF CODE TREATED TREATED <br /> NAME OF PRODUCT APPLIED <br /> V LB OZ PT QT GA <br /> 1 LB ��T QT GA ( � <br /> C .4 "' <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 OT GA <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> DATE <br /> REPORT PREPARED BY <br />