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2002 <br /> SAN JOAQUIN COUNTY <br /> r 1868 E. HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Web URL :www. co. san-joaquin . ca . us/agcomm <br /> E-Mail : <br /> office : ( 209 ) 468-3300 Recorder (NOI ) : ( 209 ) 468-3300 FAX: ( 209 ) 468-3330 <br /> ------------------------------- <br /> RESTRICTED MATERIALS PERMIT PERMIT #: 39-02-3900153 <br /> County HQ District # : D <br /> " FUGAZI , JOHN A Expiration Date: 12/31/2002 <br /> 17400 E HIGHWAY 26 - Effective Date $kf6�Yt940 <br /> LINDEN, CA 95236- <br /> JOHN A FUGAZI Home : ( 209 ) 887-2147 <br /> 17400 E HIGHWAY 26 Shop : ( 209 )887-2147 <br /> LINDEN, CA 95236- Fax: <br /> ` Mobile ( ) 401-7699 - <br /> Permittee <br /> 401-7699Permittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> Private App IXI Seasonal IXI Pass & Use IXI Phone IXI Fax IXI <br /> Q A Cert I I Job I I Pass Only I I Box IXI Modem IXI <br /> ` Ag PCO I I In Person IXI Web I I <br /> Non-Ag I I NOI required 24 hours prior to application <br /> ------------ <br /> Non-Ag Use : None <br /> Conditions : Q,W,P, Z <br /> I understand that this permit does not relieve me from liability for any damage <br /> to persons or property caused by the use of these pesticides . I waive any <br /> - claim of liability for damages against the County Department of Agriculture <br /> based on the issuance of this permit . I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacturer ' s <br /> labeling or in violation of applicable laws, regulations and specific <br /> - conditions of this permit . I authorize inspection at all reasonable times and <br /> whenever an emergency exists, by the Department of Pesticide Regulation or the <br /> County Department of Agriculture of all areas treated or to be treated, storage <br /> facilities for pesticides or emptied containers and equipment used or to be used <br /> - in the treatment . [Form PR-ENF-125 (Rev. 07/92) Pesticide Enforce <br /> A nt Branch] <br /> Permit Applicant : tiC) l ,���111. Puk=A2,1 Sign : <br /> Title : 1Q Issue nate. �v HOZ <br /> Issuing Officer : Issue Date : <br /> Page 1 <br />