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L %4.eSAN JOAQUIN COUNTY <br /> 1868 E. HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Tice: (209)468-3300 Recorder (NOI ) : (209)468-3300 FAX :-(209)46ti-3330 <br /> !ESTRICTED MATERIALS PERMIT Permit#. 39-01-3. 404227„ <br /> LCounty HO District#: G <br /> !IGHWAY 12 FARMS Expiration Date: 12/31/2001 <br /> 0 BOX 4101 Effective Date <br /> -OCKTON, CA 95204- <br /> i1CHAEL SCRIVEN Home: (209)477-1107 <br /> O BOX 4101 Shop: (209) 68-5220 <br /> 4*-OCKTON, CA 95204- Far,: <br /> Mobile: (209)483-5885 <br /> ----- -------- - <br /> rmittee Type Permit Type Possession NOi Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> 3 --ivate App [X] Seasonal [X] Poss & Use [XI Phone [XI Fax [ 7 <br /> A Cert [ ] Job 1 1 Poss Only [ 7 Box. 1X7 Modem [ I <br /> g PCO C 3 - In Person [X] <br /> Ion-Ag [ 1 NOI required 24 hours prior to application <br /> ----------------------------- -------------------------- - - <br /> . mb Pesticide Pest(s) Form. Method (s) Applicator(s) - <br /> ----- --------------- ------------ -------- ---------------- ---------------- <br /> ?1 AMINO TRIAZOLE WEEDS Liquid Ground PCO Grower <br /> r50 CARBARYL Liquid Air Ground PCO Grower <br /> 000 DICAMBA WEEDS Liquid Air Ground PCO Grower <br /> X302 DISYSTON APHID Liquid Air Ground PCO Grower <br /> 340 METHYL PARATHIO LARVAE Liquid Ground PCC Grower <br /> 4782 THIMET APHID Granules Air Ground. PCO Grower <br /> 5661 SYSTOX LARVAE Liquid Air Ground PCO Grower <br /> 360 MCPA, DIMETHYLA WEEDS Liquid Air Ground PCO Grower <br /> ,,,301 2,4-D AMINE WEEDS Liquid Air Ground PCO Grower <br /> :)r,-Ag Use: <br /> onditions: POR <br /> L -understand that this permit does not relieve me from liability for any damage <br /> -o persons or property caused by the use of these pesticides. I waive any <br /> laim of liability for damages against the County Department of _Agriculture <br /> `ased 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 /> 3ebelin.g or in violation of applicable laws, regulations and specific <br /> Dnditions of this permit. 1 authorize inspection at all reasonable times and <br /> ,n-.enever an emergency exists, by. the Department of Pesticide Regulation or the <br /> :ounty Department of Agriculture of all areas treated or to be treated, storage <br /> acilities for pesticides or emptied containers and equipment used or to be used <br /> ., the treatment. [Form PR-ENF-1225 (Rev. 07/92) Pesticide Enforcement nch] <br /> =emit Applicant: ' I C h__ - �Y N Sign : rr�, I n <br /> Title: Date: �� -L O1 <br /> Issuing Officer: Date: 1 _ r <br /> L <br />