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:�ES�RICTED TERIALS - continued ~�� <br /> ion ^ ' ^ ^ ^ Page#: 3 <br /> FLOR, DINO <br /> Perim it#: 39-01-3900146 <br /> ^� WORKERS SAFE�Y SERIES ATTACHED <br /> ,rX] through A-9 General Info. � [_] B-1 ChoIinesterase Testing <br /> =============================================================================== <br /> PERMIT CONDITIONS ATTACHED <br /> [X] P - Ge-me ral <br /> [X71 Q - Dicamba & Phenoxy �erbicides - Central Valley/Hazardous Area <br /> low [_] R - Dicamba & -hen oxys - 3pecial Hazardous Area <br /> [_] S - �etam 8odium (Vapam) <br /> [_� T - Aldicarb (Temik ) <br /> (Thiodan ) <br /> Rice Pesticides Program <br /> Molinate (Ordram> Worker Safety <br /> [_] Attachments 1-9: Molinate ( 1 ,6) thiobencarb (2,6,7) , car`ofuran <br /> X] W M e th(3,6) , methYlparathionand malathion (voluntary: 5-8) <br /> - - y1 Srom1de ' <br /> [_] Soil within greenhouses <br /> [_] Commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> gle tree site <br /> Furadan chemigation of grapes <br /> Ct�er <br /> Ono <br /> PESTI!C'1 D E SALE�: GRCi��VDWATER PRO�ECTION <br /> .__] The materiaI I am purchasing will not beused in a Pesticide Management <br /> Zone (as describesd in Section 6802, Title 3, California Code of Reg- <br /> ulations) for 'Ek gricuItural , outdoor institutional or <br /> °m use. outdoor industrial <br /> The materiaI I am purchasing will be used in a Pesticide Management Zone <br /> (as described in Section 6802, Title 3, CaIifornia Code of Regulations> <br /> agricultural , outdoor institutional or outdoczr industrial use ard a <br /> copy of my restricted materiaIs permit is attached . <br /> MateriaI purchased : [_] Atrazine [_] Simazine [_] Bromacil <br /> Diuron [_] Prometon [_] Bentazon <br /> I �e,tify under penalty of perjury that the foregoing statement is true <br /> � and that I *il � not apply any material listed Section 6800(a) in any' <br /> pestic�de Manage�en� Zone for agriculture, �utdoor insional :D- <br /> mutdoor industrial uses except in accordance with a permit issued by the <br /> _~ county agricultural cn-=iss�r,�r rr �-- �� ��� ' � �� 7 ` <br /> there is no comoissioner. - ' - <br /> Purchaser <br /> Date <br /> ' <br /> �� <br />