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Restricted Materials Permit Conditions Page#: 1 of 3 <br />-The Followings Conditions Apply To . . . . . . . . . . . . . . . . . . . . . . Permit# : 39-03-34014674 <br /> WORKERS SAFETY SERIES ATTACHED - <br />-------------------------------------------------------------------------------- <br /> [X] A-1 through A-9 General Info. [_] B-1 Cholinesterase Testing <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X] P - General <br /> [X] 0 - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R -- Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium & Metam Potassium <br /> [_] T - Aldicarb (Temik ) <br /> [_] U - Endosulfan (Thiodan ) <br /> [-] V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> [�] <br /> Attachments 1-9: Moiinate ( 1 ,6) thiobencarb (2,6,7) , carbofuran <br /> (3,6) , methylparathion (4,9) and malathion (voluntary : 7,S) <br /> [X] W - Methyl Bromide <br /> C_] Soil within greenhouses <br /> [_] Commodity <br /> C_] Soil injection <br /> [_] Tarped potting soil <br /> C_] Single tree site <br /> [_] X - Furadan chemigation of grapes <br /> [ ] Z - Other <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br />_ - - <br /> The material I am purchasing will not be used in a Pesticide Management <br /> - Zone (as described in Section 6802, Title 3, California Code of Reg- <br /> ulations) for agricultural , outdoor institutional or outdoor industrial <br /> use. <br /> [_] The material I am purchasing will be used in a Pesticide Management Zone <br /> (as described in Section 6802, 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 : [_] Atrazine [�] Simazine C_7 Bromacil <br /> [_] Diuron [_] Prometon C_] Bentazon <br /> 1 Certify under penalty of perjury that the foregoing statement is true, <br /> and that I will not apply any material listed in Section 6800(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 /> J_ ------------ <br /> Purchaser Date <br />