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SAN JOAQUIN COUNTY �DD� <br /> 1868 E . HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Web URL:www. co. san-joaquiri . ca.us/agcomm <br /> E-mail : <br /> Office : ( 209)468-3300 Recorder (NOI ) : (209 )468-3300 FAX: (209)468-3330 <br /> -- ----------------------------------------------- <br /> RESTRICTED MATERIALS PERMIT PERMIT !t: 39-02-3901041 <br /> County HQ District # : B <br /> BOURBEAU, ,PAUL Expiration Date: 12/31/2002 <br /> 16865 GAWNE ROAD Effective Date : 01 /2002 <br /> STOCKTON, CA 95215 iLI <br /> PAUL J BOURBEAU Home: 2094624508 <br /> 16865 GAWNE ROAD Shop: <br /> STOCKTON, CA 95215 Fax: <br /> Mobile . ( ) - <br /> ----------------------------------------------------------------- <br /> ?ermittee Type Permit Type Possession . NOI Method of submission <br /> -------------- ------------ -------------- -------------------------- <br /> -Private App JXJ Seasonal AXI Poss 6 Use JXI Phone (XI Fax 1XI <br /> Q A Cert I j Job ( ( Poss Only I ( Box AXI Modem I I <br /> 4g POO f In Person 1X) web 1XI <br /> -son-Ag NOI required 24 hours prior to application <br /> Ton-Ag Use: None <br /> -Conditions: PQUWZ <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 waive any <br /> zlaim of liability for damages against the County Department of Agriculture <br /> cased on the issuance of this permit . I further understand that this permit <br /> nay be revoked when pesticides are used in conflict with the manufacturer' s <br /> labeling or in violation of applicable laws, regulations and specific <br /> 2onditions of this permit . I authorize inspection at all reasonable times and <br /> whenever an emergency exists, by the Department of Pesticide Regulation or the <br /> —County Department of Agriculture of all areas treated or to be treated, storage <br /> facilities for pesticides or emptied containers and equipment used or to be used <br /> in the treatment . [Form PR-ENF-125 (Rev. 07/92 ) Pesticide Enforcement Branch] <br /> Permit Applicant : 1tZ �,,rA ►) Sign: <br /> Title: Issue Date: <br /> Issuing Officer: Issue Date : - <br /> Page 1 <br />