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APPLICATION - RESTRICTED MATERIALS - SUPPLEMENT PERMIT NO. <br /> r (.t, PAGE NO. <br /> MAP ACRES/ DILUTION/ DATE/ <br /> OCATION SEC TWN PING ID COMMODITY UNITS PESTICIDES PESTS F' M" RATE VOLUME APPL TIMING <br /> Fir <br /> 10. <br /> 11. <br /> 12. <br /> 13. <br /> 14. <br /> 15. <br /> 16. <br /> 17. <br /> 18. <br /> 19. <br /> 20. <br />)1. <br /> 22. <br />�3. <br />�4. <br />�5. <br />�6. <br />?7. <br />�8. <br /> 29. <br /> 30. <br /> 31. <br /> 32. <br /> 33. <br /> Formulation: L—Liquid B—Bait D—Dust F—Fumigant G—Granules APPLICANT SIGNATURE DATE <br /> WP—Wettable Powder O—Other w� <br /> 'Method: A—Air F—Fumigation GR—Ground O—Other ISSUED BY DATE <br /> IISTRIBUTION:WHITE 8 YELLOW—COUNTY:PINK&GOLD—PERMITTEE OSP 02 66861 PESTICIDE ENFORCEMENT BRANCH PR-ENF-125A(Rev.0/00) <br /> �� / <br />