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Feimitte:GRiTPE,ItiARI. <br /> PermitNwnber: 39-06-3900193 <br /> Detription of Con(Utfons on this Petmtt: <br /> Condition ID Description <br /> A Permit Cond.Table of Contents <br /> A-PERMIT CONDITIONS-TABLE OF CONTENTS <br /> WORKMS SAFETY SERIES ATTACHED <br /> [ ]A-1 through A-11 General Information <br /> PERMIT CONDITONS AJTACHM <br /> [X] P - General <br /> [ j Q-Dicarnba&Phenoxy Herbicides-Central Valley/Hazardous Area <br /> [ ] R- Dicamba&Phenoxyg-Special Hazardous Area <br /> [ ] S- Metam Sodium&Metam Potassiurn <br /> [ ] T- Aldicarb(Temik) <br /> [ ] U- Endosulfan(Thiodan) <br /> [ ] <br /> V- Rice Pesticides Program <br /> [ ]-Molinate(Ordram)Worker Safety(A) <br /> [ ]-Attachments 1-10: Molinate(1,6),Thiobencarb(2,6,7), <br /> Methylparathion(3,9),Seepage Control(5), <br /> Propanil(10)and Malathion(voluntary:4,S). <br /> ( ]W-Methyl Bromide <br /> [ ]-Soil within greenhouses <br /> [ ]-Commodity <br /> • [ ]-Soil injection <br /> [ ]-Tarped potting soil <br /> [ ]-Single tree site <br /> [ J X-Furadan chemigation of grapes <br /> [ ]Y- 1,3-Dichloropropene <br /> [ )Z-Other <br /> PESTIc"1DE SALES: GROUNDWATER PROTECTION <br /> [ ]The material I am purchasing will not be used in a Pesticide Management Zone(as described in Section 6802, <br /> Title 3,California Code of Regulations)for agricuttw-al,outdoor institutional or outdoor industrial use. <br /> [ )The material I am purchasing will be used in a Pesticide Management Zone(as described in Section 6802,Title 3, <br /> California Code of Regulations)for agricultural,outdoor iustitntional or outdoor industrial use and a copy of my <br /> restricted materials permit is attached. <br /> Material purchased: [ ) Atrazine ( ) Simazine [ ) Bromacil <br /> [ ] Duron [ j Prometon ( ] Benrazon <br /> I certify under penalty of perjurythat the foregoing statement is true, and that I will not apply any material listed in <br /> Section 6800(a) in any Pesticide Management Zone for agriculture,outdoor institutional or outdoor industrial uses <br /> except in accordance with a pennit issued by the county aV icuffixal cornmissioner or the director in a county in <br /> 4tberecommissior er--- <br /> Date <br />