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- VT SAN JOAN:UIN COUNT(j i <br /> 18-68 E. HA7EL-TON AVENUE <br /> STOCKTON, CA 95205 <br /> office: (209)468„ --33C£) Re (209)468-3300er (N_ I (209)468-3300 FAX: 3. <br /> I I� <br /> RESTRICTED MATERIALS PERMIT PERMIT/OPERATOR I . D. #: 39-96-3900211 <br /> Courrty HQ District #: H <br /> ` HOLM STEVE " Expiration Dote: 12/31/96 <br /> 5533 E. QUASHNICK !y issue Efate: 02/29/96 <br /> STOCKTON, GA 95212 <br /> -3946 <br /> Home: (209)9:31 <br /> - STEVE HOLM ! - <br /> 55a3 E. QUASHNICK II Chop: ( ) <br /> STOCKTON, <br /> ==GA_=95212 ,! M o b i i e° <br /> FOR RESTRICTED MATERIALSIPERMIT-USE ONLY <br /> I' I' Permit Type: Foss. Only 1 Seasonal : X 1 Fess. & Use ! X : Job <br /> Permittee Type: O.A. Gert 1 1 As. PCOi Private App 1X1 Nun-As 1 1 <br /> i ' NGT required 24 hours Prior to application. �pi� <br /> Method Phone 1X : box I. X1 Person i X i m{�dERr i i fax : k : <br /> -Numb- Pesticide___ ___Pest ( s )__ _Formal-` Method(s ) --Ap licator-(s )-- <br /> 1.360 CHLOROPICRIN Nematode Fumisa.nt Ground PCO Grower <br /> 1980 DIAZINON Larvae Liquid Ground PGC! Grower <br /> 385£ METHYL BROMIDE Sail /Stored Fumigant Ground FGO Grower <br /> 4840 ALUMINUM FHOSPH Rodents Fumisant ground FCC! Grower <br /> 4U STRYCHNINE Gophers Ela.it Gr ound PCs` Grower <br /> =� <br /> 6260 ZINC: PHOSPHIDE Rodents Bait Ground PC-O i [Trower <br /> 98 - ! K <br /> _ . Lal �:f,4 L AMINE WFed Liquid Cr•cund PGG i `rr.,wcr <br /> 16011 PARAQUAT Weeds Liquid Ground FC:G Grower <br /> 16891 SLIPRACIDE Larvae Liquid Ground POO Grower <br /> 22941 ASANA Larvae Li+vuid Ground PCO_ Grower <br /> 99901 ENVY 2, 4-D AMIN Weeds Liquid Ground PCO I Grower <br /> ----- ---------------- ------------ -------- L--------------- ---- <br /> a . ----- ---------------- ------------ __--- = ------------ -- <br /> ---- k-_--__- _-___ <br /> Non-Ag Use: <br /> Conditions: PQW l0 <br /> I understand-that-this Permit does not-relieve me from liability-for-any damage <br /> to Persons or property caused by the use of these Pesticides. I Iwaive any <br /> claim of liability for da.mases against the C6unty Department of Agriculture <br /> h <br /> fused on the issuance of this Permit. I further- understand that tis permit <br /> may be revoked when Pesticides are used in c6nflict with the manufacturer's <br /> labeling or- in violation of applicable laws, ilregQlations and '�rpeci�lfic <br /> conditions of this Permit. I authorize inspection at all reasonabile times and <br /> whenever art emergency exists, by the Department of Pesticide Regula' n or the <br /> County Department of Agriculture of all areas treated or to be 'treated, storage <br /> facilities for• Pesticides or emptied contairrer•s and equipment used or- to be <br /> used in the treatment. [Form 33-125/vZ3.r3 (Rev. 02/16/9C►) Pe e 4nonce Errt <br /> i <br /> Branch] Y - <br /> . - ;ry '/� � l <br /> Permit Applicant: �' - «�s <br /> __ _ �1!��L1Sign: <br /> n <br /> � <br /> q — 'L <br /> Title: � ______-- �� - Da t E <br /> 5 s t1 i ns Of f i.c e r•• --'�\t�"�-''�-tat e: -2::!'-� �._.L ----------- <br /> - II <br /> I <br />