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Restricted Materials Permit Conditioner Page4 : 1 of a <br /> The Following Conditions Apply To . . . . . . . . . . . . . . . . . . . . . . Pe.rmit# : 39--03-3900351 <br /> ---WORKERS SAFETY :SERIES ATTACHED <br /> EX] A-1 through-A-9 General Info . [_] B--1 Cholinesterase Testing; <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X] P General <br /> [XI Q - Dicamba & Phenoxy Herbicides -- Central Valley/Hazardous. Area <br /> [_] .R - Dinamba & Phenown - Special Hazardous Area <br /> [ [_] S - Me:tam Sodium & Metam Potassium <br /> C_] T - Aldicarb (Temik) <br /> C_] U Endosulfan (Thiodan) <br /> [_] V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> [_] Attachments 1-9: Molinate (1 , 6) thiobencar'b (2, 6,7 ) , carboturan <br /> (3, 6) , methylparathion (4,9) and malathion (voluntary: 5 ,8) <br /> [X] W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> [_] Commodity <br /> C_1 Soil injection <br /> C_] Tarped potting :soil <br /> C_] SinWe: tree site <br /> [_] X - Furadan chemigation of grape.w: <br /> C._] Z - Other <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ------------------------------------------------------------------------------- <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 , outdc"op institutional 1:n outdoor industrial <br /> use . <br /> [ 1 The. material 3 am purchasing will be; used in a Pesticide Management Zone <br /> Cas 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: C_1 Atrazine C_1 Simazine [_1 Fr•omac:il <br /> C_1 D. 'Ur-On [_] Prometun [_] Bentazon <br /> I Certify under penalty of perjury that. the='. foregoing statement is true, <br /> and that J will not apply any material listed in Section E800(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 is no commissioner . <br /> -._--- ___ <br /> Purchaser ....___--- <br /> __- Date <br /> t <br />