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_ Restricted Materials Permit Conditions Page# : 1 of 3 <br /> The Following Conditions Apply To . . . . . . . . . . . . . . . . . . . . . . Permit#: 39-03-3900444 <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------- ---- --- --------------------------------------------------- ---------- <br /> [X] A-1 through A-9 General Info. [_] B-1 Cholinesterase Testing <br /> _ 7 <br /> PERMIT CONDITIONS ATTACHED <br /> [X] P - :.general <br /> " [X] Q - Dicamba &• Phenoxy Herbicide;. -- Central Valley Hazardous Area <br /> [_-1 R - Dic-amba &. Phenoxys - Special Hazardous Area <br /> [_; S - Metam Sodium & Metacr, Potas� ium <br /> [_] T Aldicarb (Temik) <br /> [_] U - Endosulfan (Thiodan) <br /> [_] V - Rice Pesticides Program <br /> [_] Moiinate (Ordram) Worker Safety <br /> [_] Attachments 1-9: Molinate ( 1 ,6) thiobencarb (2,8,7) , c:arbofuran <br /> (3,6) , methylparathion (4,9) and malathion (voluntary: 15,S) <br /> [_] W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> [-] -Commodity <br /> [_] Soil injection <br /> .- [_] Tarped potting soil <br /> [_] Single tree site <br /> X - Furadan chemigation of grapes <br /> [_] Z Other <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <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: [_; Atrazine [_] Simazine [_] Bromacil <br /> [_] Diuron [_] Prometon [_] BentaLon <br /> I Certify under penalty of perjury that. the foregoing st.at,e .ent. is `rue, <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 /> �r <br /> ��ui7`ty agricultural ��r;Ik;ii:::iJrit'i 2` �::c ` s-+ �` - � <br /> ` dyl. G�-l•'7 ii :.i. <br /> there is no commissioner. <br /> Purchaser Date - <br />