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RESTRICTED MATERIALS PERMIT cant . page 3 <br /> n <br /> PHILLIPS , RICHARD eermit 9 : 39-96-3901284 <br /> __ WORKERS-SAFETY SERIES ATTACHED <br /> L'------------------------------------------------------------_---------------------- <br /> (X] A-1 through A-9 General Info . ; [_] B-1 Cholinesterase Testing <br /> d PERMIT CONDITIONS ATTACHED <br /> --------------------------------------------, ---_-__-_____-------------_------- <br /> �� [X] P - General <br /> F. [X] Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) - Sprinkler Irrigation Application <br /> [_] T - Aldicarb (Temik) <br /> (_] U - Endosulfan (Thiodan) <br /> [_] V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> F [_] Attachments 1-9 : Molinate. ( 1 , 6 ) thiobencarb ( 2 , 6 , 7 ) , carbofuran <br /> ( 3 , 6 ) , methylparathion ( 4 , 9 ) and malathion (voluntary: 5 , 8 ) <br /> [X] W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> [_] Commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> [ ] Single tree site <br /> [_] X - Fu'radan chemigation of grapes <br /> Z Other <br /> PESTICIDE SALE==---_____________________-_--________________ <br /> S :, GROUNDWATER PROTECTION <br /> -_- ---------------------------------------------------------- <br /> [ T e 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 /> �r for agricultural , outdoor institutional or outdoor industrial use and a <br /> copy of my restricted materials permit is attached. <br /> Materia? purchased : [_] Atrazine [_] Simazine [_] Bromacil h <br /> Diuron [_] Prometon [_] Bentazon <br /> I Certify under penalty of perjury that file 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 /> the e is no commissioner. <br /> 91- <br /> - - vi-- --------- - may � --- <br /> Purchaser Date <br /> ] <br />