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r <br /> _ WORK SITE PLAN <br /> Methyl Bromide A: GENERAL INFORMATION <br /> Commodity Fumigation <br /> Description This Work Site Plan has five sections: <br /> Section A records general information about the work site. <br /> Section B records compliance with general permit conditions. <br /> Section C is used to determine the size of the buffer zones. <br /> Section D records compliance with other specific conditions. <br /> Section V.records information for alternate conditions. <br /> Instructions The Work Site plan must be completed and submitted to the <br /> County Agricultttral Commissioner, The Work Site Plan is <br /> considered complete when all the questions in the appropriate <br /> sections are answered. After the completed Work Site Plan is <br /> evaluated by the Agricultural Corr ,ntissioner,Restricted Materials <br /> Permits must be issued to both.the facility operator and pest <br /> control business, if applicable. <br /> A Restricted Materials hermit cannot be issued unless <br /> all questions in the appropriate teetions are <br /> answered, lNCort•ect itti~arttldtihd ()it the Work Site <br /> - Plan will result in dedial bf the permit. <br /> Fumigation Site: DELTA PACKING CO. , OF LODI INC. <br /> Address: 5950 -E. KETTEEMAN City: LODI . Zip: 95240 <br /> Contact Person: ems¢= ��v ,� �Cem°J^ t4c-�irk-Pltfone: (209) 334-1023 <br /> (Facility operator.Grower,QAC Ucensee,etc.) <br /> Pest Control Business: Permit Number: <br /> Address: City: Zip. <br /> Contact Person: Phone: <br /> (Facility Operator,Grower,QAC Ucensee,etc.) <br /> I VERIFY T14AT THE FOLLOWING INFORMATION IS ACCURATt AND TRUE TO THE <br /> BEST OF MY KNOWLEDGE. <br /> Date: <br /> Signature: •f �/ l <br /> Title: <br /> �l <br /> 8/8/94 <br />