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vRESTRICTED MATERIALS PERMIcontinued . . . . . Page# : 6 <br /> PODESTA FARMS, FRED Permit.# : 39-99-3900351 <br /> ----------- <br /> I'� WORKERS SAFETY SERIES ATTACHED <br /> ------------------- ------- ------- -- - - ------ ------------ - <br /> [X] A-1 through A-9 General. Info. [_] B-1 Cholinesterase Testing <br /> i <br /> ---------- <br /> PERMIT CONDITIONS ATTACHED <br /> --------------- ------------------------- - ----------- ---------- -------------- --- <br /> [X] P - General. <br /> [X] Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> 1 [ ] R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) <br /> [ ] T - Aldicarb (Temik) <br /> [X] U - Endosulfan (Thiodan) <br /> [ ] V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> [_] Attachments 1-9 : Molinate (1, 6) thiobencarb (2 , 6 , 7) , carbofuran <br /> (3 , 6) , methylparathion (4 , 9) and malathion (voluntary: 5, 8) <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 /> ------------ ------------------ ------ -- - - ------------------------ - -------------- <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 U 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 (x) 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 Date <br />