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RESTRICTED MATERIALS PERM continued . . . . . Page#: 4 <br /> DELTA PACKING Permit#: 39-01-3904123 <br /> WORKERS SAFETY SERIES ATTACHED <br /> ---------------------------------------------------- <br /> CX] A-1 through A-9 General Info . [_] 3-1 Cholinesterase Tes-ing <br /> ------------------------ <br /> PERMIT CONDITIONS ATTACHED <br /> -------------------------------------------------------------- <br /> [X ] P - General <br /> C_7 Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) <br /> [_] T - Aldicarb ( Temik ) <br /> C_] U - Endcsulfan ( Thiodan ) <br /> [_] V - Rice Pesticides Program <br /> C—] Molinate (Ordram) Worker Safety <br /> C_7 Attachments 1-9: Molinate ( 1 , 6 ) thiobencarb (2,6, 7) , carbofuran <br /> (3,6 ) , methylparathion ( 4, 9) and malathion (voluntary : 5,S) <br /> CX ] W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> C_] Commodity <br /> C_] Soil injection <br /> [_] Tarped potting soil <br /> [_] Single tree site <br /> C_] X - Furadan chemigation of grapes <br /> CX] Z - Other <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 C_] Simazine C_] Bromacil <br /> [ ] Diuron [_] Prometon [_] Sentazon <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 /> r� / y1- -�l----- <br /> ----- ------- <br /> Purchaser Date <br />