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SAN JOAt,UIN COUNTY <br /> 1868 E . HA'2:ELTON AVENUE x063 <br /> STOCKTON. CA 95205 <br /> web URL:www. co . san-joaquin . ca. us.lagcomm <br /> E-M--il ! <br /> Office : ( 209 ) 468-3300 Recorder (NOI ) : ( 209) 468-3300 FPY: ( 209 )468-3330 <br /> ---_-------------- <br /> RESTRICTED MATERIALS PERMIT PERMIT #: 39-03-3904227 <br /> County HQ District #: G <br /> HIGhWAY 12 FARMS Expiration Date: 12/31/2003 <br /> P O BOX 4101 Effective Date : 01/08/2003 <br /> V STOCKTON, CA 95204- <br /> MICHAEL SCRIVEN Home : f209 )477-1107 <br /> 6. P O BOX 4 10 1 Shop : (209 )368-5220 - <br /> STOC=, N, CA 95204- Fax: <br /> Mobile . ( 2095483-5885 <br /> ------------- <br /> --------------------------- - <br /> -'ermittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> 4•rivate App AXI Seasonal AXI Poss & Use �X� Phone �X( Fax <br /> p A Cert I ! Job Ij Foss Only Box 1X! Modem F <br /> .g PCO ( In Person IXI Web I I <br /> 'on-Ag NOI required 24 hours prior to application <br /> �==oc=vo=-=oc=o==ccoccc=oocc===o=_ _==oco=000=cv==v=ee-c===ov <br /> con-Ag Use : None <br /> "onditiors : PQR. <br /> �+ 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 /> -laim of liability for damages against the county Department of Agriculture <br /> ;aced on the issuance of this permit . I further understand that this permit <br /> -!-�,ay be 'revoked when pesticides are used in conflict with the manufacturer 's <br /> labeling or in violation of applicable laws, regulations and specific_ <br /> -onditions of this permit . I authorize inspection at all reasonable times and <br /> .henever an emergency_ exists, by the Department of Pesticide Regulation or the <br /> 4 ounty Department of Agriculture of all areas treated or to be treated, storage <br /> facilities for pesticides or emptied containers and equipment used or be used <br /> �-.n the treatment . [Form PR-ENF-125 (Rev. 07/92 ) Pesticide PLinfoitcemen anchj <br /> LSe�«� <br /> Permit Applicant : M��-ffy � Sign : <br /> Title: Issue Date . <br /> Issuing Officer : if i - Issue Date . <br /> L <br /> L Page 1 <br /> L <br /> L <br />