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wool <br /> RESTRICTED MATERIALS PERMIT continued . . . . . Page#: 3 <br /> 7LOR, DINO Permit# : 39-00-3900146 <br /> WORKERS SAFETY SERIES ATTACHED <br /> = [X] A-1 through A-9 General Info . | [_] B-1 Cholinesterase Testing <br /> PERMIT CONDITIONS ATTACHED <br /> [X] P - General <br /> ^~ [X] Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) <br /> _~ [_] T - Aldicarb (T e m i k ) <br /> [_] U - Endosulfan (Thiodan ) <br /> [_] V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> =~ [_j Attachments 1-9: Molinate ( 1 ,6) thiobencarb (2 ,6, 7) , carbofuran <br /> (3,6) , methylparathion (4,9) and malathion ( voluntary: 5,B) <br /> [X] 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, TitIe 3, California Code of <br /> Reg-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 [_] 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 wit� a permit issued by the <br /> county agricultural commissioner or the director in a county in which <br /> there is no COM1,71 <br /> -----+==��/"�=--+c��~�==°'�=--i Urchaser Date <br /> _ <br /> _ <br />