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1 ' <br /> i.. `/ SAN JOAQUIN COON—If It'd A007d <br /> 1868 E. HAZELTON AVENUE <br /> STOCKTON, CA_ 95205 - <br /> 6. Web UPS.:-.•ww. co .san-joaquin . ca.us/agcomm <br /> E-mail : <br /> �- office : ( 209 )4681-3300 Recorder (NOI ) : ( 209 )468-3300 FAX: ( 209 )468-3330 <br /> L ________________ <br /> RESTRICTED MATERIALS PERMIT PERMIT #: 39-02-3904227 <br /> County HQ District 1X: G <br /> b. HIGI-FWAY 12 FARMS - Expiration Date: 12/31/200-1 <br /> P O SOX diol Effective Date . 01/17/2002 <br /> STOCK_TON, CA 95204- <br /> 6. <br /> MICt-iAHL SCRIVEN Home : (209) 477-1107 <br /> P O BOX_ 4101 Shop : (209)368-5220 <br /> r. STOCKTON, CA 95204- Fax: <br /> B:obile (2091A83-5855 <br /> Permittee - ype Permit Type Possession NoI Method. of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> .Private App {X{ Seasonal - {XI Foss s Use {xj Phone {xI Fax I I <br /> O A Cert { t Job Poss Only { Box {X{ Modem <br /> Ag PCO ; ! _ In Person IXI Web I I <br /> Non-Ag I { - - NGl required 24 hours prior to application <br /> ----------------------------------------------------------------------- <br /> Non-Ag Use : None <br /> `Conditions : PQR <br /> `I understand that this permit does not relieve me from liability for any damag_- <br /> to persons or property caused by the use of these pesticides . 1 waive any <br /> -claim of liability for damages against the County Department of Agriculture <br /> based on the issuance of this permit . I further understand that this permit <br /> .may be revoked when pesticides are used in conflict with the manufacturer 's <br /> labeling or in violation of applicable laws, regulations and specific <br /> conditions 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 user <br /> in the treatment . [Form PR-ENF-125 (Rev. 07/9.21 Pesticide Enfe-cemen anch] <br /> LPermit Applicant ' MkCALyp�o�- Sign : <br /> Title: Issue Date : <br /> Issuing Officer! 1 <br /> Ia^sue Data : <br /> Page 1 <br /> I <br /> L <br /> L <br /> L <br /> L <br />