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RESTRICTED MATERIALS PEROT`T continued . . . . . `me Page# : 3 <br /> DELTA PACKING Permit# : 39-00-3904123 <br /> --------------------------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X] A-1 through A-9 General Info. [_J B-1 Cholinesterase Testing <br /> ---------------- <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X] P - General <br /> [_7 Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardcus Area <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) <br /> [_] T - Aldicarb (Temik ) <br /> -� [_J U - Endosulfan (Thiodan) <br /> [_] V - Rice Pesticides Program <br /> [_J 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 /> [ >C] Commodity <br /> [_J Soil injection <br /> [_] Tarped potting soil <br /> [_J Single tree site <br /> [_J X - Furadan chemigation of grapes <br /> Z - Other <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <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 /> [_J Diuron [_] Prometon [_1 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(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 /> Purchaser Date <br />