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' <br /> ��ESTR��TED �ATG�RIALS PE��� <br /> | . <br /> r <br /> POD�ST� FA��S, F�ED �erm�t #: 39-�8-�900351 <br /> =============================================================================== <br /> WORKERS ��FETY SERIES ATT�CH�D ' <br /> �X3 A-1 Ch�Iine�tera�e Testin� <br /> =============================================================================== <br /> PERMIT T%O��S ��7TACHED <br /> �X] P - General <br /> Pbeoaxy Her�ici�es - C�ent�aI VaIley/Hazard�u� Area <br /> Phenox�s - S�eciaI Ha�ardou�� Area <br /> L_] S - Metam Sudium {Vapam) <br /> �mdosulfan <Thiodam ) <br /> Pessticides IFrc,g�am <br /> norkr Safety <br /> i - <br /> [ ] A�tachmeots 1-9: Molinate ( 1 ,6) thiobencarb �2,6,7) , carb�furan <br /> ( _ <br /> met�yl��ratbion (vn3u�t�ry: 3,B) <br /> ( [_� �oiI withim gree�houses <br /> ' [_] Commodity <br /> [_] Soil injection <br /> potting soil <br /> Single 1'. �ite <br /> Fura6an che�igat�on of grapes <br /> C.ther <br /> � <br /> ) <br /> PESTlCIDE SALES: 6ROUNDW�TER PROTECTIUN <br /> [_] T�e materi�l I a� �urchasing wiIl not be used �� a pestic��e �an�gement <br /> Zone (as d�scribed im Sect�on 6B02, Title 3, �aliforni�� Code mf Reg- <br /> alations,) f��r agr�cuItural , outdoor instit�ati�nal or outdoor ��d�strial <br /> uSo. <br /> [_] The �a+erial I am purchasing v:il l be uagemen� Zone <br /> (as desscribed in �ection ��02, T4.1. 3, California [�ode of Recmlations) <br /> f�r agricul�ural � mut���r institu�ionaI nr out�oor industrial use an� a <br /> co�y of my �est�ic�ed matc�rials p�rmit is attached . <br /> �ateria1 purc�as�d : [_] At�az�oe �_] S�m*z�ne [_] Brom�cil <br /> � r� penal ty of pei It the foregolng s�tatement is �ru�, <br /> and that I wil l mot a�pIy ny meterial � �sted Sectm 6800(.$) in any <br /> �amagement Zone for a�ricuIture, cutdoor institutionaI or <br /> outdoor imdustria� uses excep� i� accordanc�e �vit� a permit issued by the <br /> coont� agri�ul taral comn issimm�sr or ��e direct�r i� a c«�unty �n which <br /> t�ere is nc� commiss�oner. <br /> Pur�ha�e� Date <br />