Laserfiche WebLink
RESTRICTED MATERIALS PERMIT continuer G'-•• � ' <br /> ,,,FUGAZ I , JOHN A <br /> 1JnRKf=Pq SAFFTY 9r.RT=R <br /> ------------------------------------------------------------------------- <br /> b-9 Gi nPrA! Tnfn. - r I R-1 rhnl ina;t} rase Testing . <br /> PFRMTT CONDITIONS ATTACHED <br /> --------------------------------------------------------------- <br /> Xl <br /> 'x n - Micamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> -? R - Dicamba & Phenoxys - Special Hazardous Area <br /> m <br /> ] S - MetaSodium (Vapam) <br /> [_] T - Aldicarb ( Temik ) <br /> C_] U - Endosulfan (Thiodan ) <br /> C_] V - Rice Pesticides Program <br /> C-1 Molinate (Ordram) Worker Safety <br /> C_] Attachments 1-9: Molinate ( 1 ,6) thiobencarb (2,6,7) , carbafuran <br /> (3,6) , methylparathion (4,9) and malathion (voluntary: 5,B) <br /> [X] W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> C_7 Commodity <br /> [_] Soil injection <br /> C_] Tarped potting soil <br /> [_] Single tree site <br /> r_] X - Furadan chemigation of grapes <br /> C_] Z - Other <br /> ------------------------------------- <br /> ' PESTICIDE SALES: GROUNDWATER PROTECTION <br /> -------------------------------------------7----------------------------------- <br /> [_] The material I am purchasing will not be used in a Pesticide Management <br /> Zone (as described in Section 6802, Title 3, California Code of Reg- <br /> ulations) for agricultural , outdoor institutional or outdoor industrial <br /> use. <br /> ` [_] The material I am purchasing will be used in a Pesticide Management Zone <br /> (as described in Section 6802, Title 3, California Code of Regulations) <br /> for agricultural , outdoor institutional or outdoor industrial use and a <br /> copy of my restricted materials permit is attached . <br /> Material purchased: E_] Atrazine E_] Simazine C_] Bromacil <br /> C_] Diuron L_7 Prometon C_] Bentazon <br /> I Certify under penalty of perjury that the foregoing statement is true, <br /> and that I will not apply any material listed in Section 6800(a) in any <br /> Pesticide Management. Zone for agriculture, outdoor institutional or <br /> ` outdoor industrial uses except in accordance with a permit issued by the <br /> county agricultural commissioner or the director in a county in which <br /> there no ommis=_ion <br /> Date <br /> Purchaser <br />