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,_RESTR,ICTED MATERIALS PERMIT cont,, Page 4 <br /> VcV FARMS Permit #: 39-97-3904674 <br /> WORKERS SAFETY SERIES ATTACHED <br /> [XJ A-1 through A•-9 General Info,. ; [_1 8•-1 Cholinesterase Testing <br /> PERMIT CONDITIONS ATTACHED <br /> [XI P - General <br /> I_Xj Q - Dicamba & Phenoxy Herbicides - Central Valley,/Hazardous Area <br /> [_I R - Dicamba & Phenoxys Special Hazardous Area <br /> S - Met,arr Sodium ('Vapam) - Sprinkler Irrigation Application <br /> [_.I T - Aldicarb (Temik) <br /> U - Endosulfan (Thiodan) <br /> I-_I V Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> [_I Attachments 1-9: Molinate ( 1 , 6) thiobencarb (2,6 , 7) , carbofurar, <br /> (3,6) , methylparathion (4, 9) and malathion (voluntary:: 5,S) <br /> [X] W Methyl Bromide <br /> [_] Soil within Qreenhouses <br /> Commodity <br /> [_] Soil injection <br /> [ I Tarpec! pt.ting soi].. <br /> �. � _] Single tree site <br /> X - Furadan chemigation of grape., <br /> Z - Other <br /> PESTICIDE SALES: GR.OU!NDWATER. PROTECTION <br /> The <br /> _material I-arn purchasing �-vill-not-be-used in a-Pesticide Management <br /> Zone (as describes! in Section 6802, Title 3 , California Code of Rc:g- <br /> _!lations ) for agricultural , outdoor institutional or ot!tdoor industrial <br /> use . <br /> The material I am purchasing will be used in a Pesticide Management Zone <br /> (as described in Section 6602 , Title 3, California Code of Regulations) <br /> .For agricultural , outdoor institutional or outdoor industrial use and a <br /> copy of my restricted materials permit is attached. <br /> Material purchased ;. [_] <br /> Atrazine ( 1 Simazine �rornac.il <br /> Diuron [_I Prome ton [--I Bentazon <br /> .a Certify under penalty of perjury that the foregoing statement is true, <br /> and that. I will not apply any material listed in Section 6&30(a) in any <br /> Pesticide Management Zone for agriculture, outdoor institutional or <br /> OUtdoor industrial uses except in accordance with a permit issued by the <br /> county agricultural commissioner or the director in a county in which <br /> there is no commissioner., <br /> 17"17 <br /> Purchaser Date <br />