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SAN JOAQUIN COUNTY <br />'f 1868 E. HAZE ,TCN AVENUE <br /> STGCKTCN, CA 95205- <br /> Ermail' Web:www.co.ssm joaquirca.usfapGrnm <br /> Office: (209)468.3300 Fax: (209)468.3330 Recorder(NON)' (209)468-3300 <br /> RESTRICTED MATERIALS PERMIT <br /> Permit Number: 39-09-3904100 <br /> COSTAMAGNA,P &L <br /> County District#: G17046 N DEVRIES RD <br /> LODI, CA 95242- Expiration Date: December 31,2009 <br /> Effective Date: <br /> ,Mum 6 <br /> 1 <br /> F-4 PEM COSTAMAGNA Hone Phone: <br /> 17046 N DEVRIE.S RD Shop Phone: <br /> I r LODI, CA 95242- Mobile Phone: <br /> j Fax: <br /> Permittee `Type: QAC/QAL NOI Method of Submission:, <br /> Permit`.Type: Seasonal Phone: X Fax: X Box: <br /> Possession: Possession & Use In Person: X Modem Web: X <br /> F.01 required 24 hours prior to application. <br /> Conditions: A,P,Q,GWP-R3,GWP-L2,GWP-L3 <br /> III p ( 5eeend ofpermit for <br /> �^ code desttiptiom. <br /> ..------------------- damages persons property caused -------- <br /> k 1_ liability for and F�� Y <br /> t this permit does not relieve me frotx�Itab ty y arxiag y p <br /> I understand that p <br /> by the use of these pesticides. I waive any claims of liability for damages against the county Department of <br /> Agriculture based on the issuance of this permit. I further understand that this permit may be revoked when. <br /> k + pesticides are used in conflict with the manufact r&s labeling or in violation of applicable laws,regulations and <br /> specific conditions of this permit_ I authorize inspection at all reasonable times and whenever an emergency exists <br /> i by the Department of Pesticide Regulation or the County Department of Agriculture of all ares treated or to be <br /> treated,storage facilities for pesticides or emptied containers and equipment used or to be used in the treatment. <br /> [Form PR-ENP'-125 (Rev. 07/92)Pesticide Enforcement Branch] <br /> E Pemnitpplica� Signed <br /> (PIease Prrrrt <br /> 'lute: a WIU'7'� Issue Date:F1 z-+ Z O f� <br /> este Print <br /> Issuing Officer <br /> Lh� <br /> Issue Date: 124 a.a Q <br /> F.; <br /> Fil' <br />