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'STATE OF CALIFORNIA �j �+ DEPARTMENT OF PESTICIDE REGULATICN <br /> I V A i�p"E APPLICATOR PESTICIDE ENFORCEMENT SR=,-, <br /> ERTIFICATION STATEMENT <br /> rn-ENF-172(EST.7191[ <br /> CERTIFICATION EXPIRATION DATE <br /> �IVATE APPLICATOR NAME APPLIOATOA <br /> FF�� PHONE NUMBER <br /> LL , ._ 'h ,= 1 Y 8SS 2.417(0 <br /> DRESS <br /> Z2 t RD. P4A17ee-4 CoA , 5 334 <br /> urRTIFYING COUNTY NAME PERMIT NUMBER ISSUED COUNTY PHONE NUMBER <br /> 16 AJ tai 3 317119128 41 3/9 <br /> RTIFICATIO PERMtT ED BY; TIT r <br /> CERTIFICATIO ED: <br /> U GENERAL EXAMINATIOWORKER SAFETY EXAMINATION <br /> U <br /> �FSTICIDE SAFETY SERIES INFORMATION PROV16EI PESTICIDE SAFETY SERIES INFORMATION[SERIES NUMBERS[PROVIDED]: <br /> I %YES ❑ NO <br /> ertify the above information is correct and that t have taken the Private Applicator Certification examination for the possession <br /> ,]dlor use of restricted use pesticides. 1 have reviewed and understand questions answered incorrectly with the issuing county. <br /> CCEERTIFI RI APPLI ATO ATURE DATE SIGNEDICERTIFIED <br /> ;E ' 4' i�C �� - 2, l <br /> Ltribupon: Original—County Canary--Certified Private Applicator Pink —Copy <br /> STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATION <br /> rIVATE APPLICATOR PESTICIDE ENFORCEMENT BRANCH <br /> ERTIFICATION STATEMENT <br /> rr,-ENP•172(EST.7/91) CERTIFICATION EXPIRATION DATE <br /> 1/ — <br /> NATE APPLICATOR NAME APPMATOR PHONE NUMBER <br /> -lilt <br /> KESS <br /> 1`2 a <br /> %cRTIFYING COUNTY NAME PERMIT NUMBER ISSUED COUNTY PHONE NUMBER <br /> ¢ 39- <br /> RTIFICATIO MIT ISS TITLE <br /> f <br /> CERTIFICATION ISSUED: .01 <br /> GENERAL EXA TION WORKER SAFETY EXAMINATION <br /> �r <br /> PSTICIDE SAFETY SERIES INFORMATION PROVIDED: PESTICIDE SAFETY.SERIES INFORMATION[SERIES NUMBER(S)PROVIDED]: <br /> /1 IT-YES NO <br /> 1t_ <br /> ertify the above information is correct and that l have taken the Private Applicator Certification examination for the possession <br /> id/or use of restricted use pesticides. t have reviewed and understand questions answered incorrectly with the issuing county. <br /> f <br /> CE�TIFIEDP VATS PL <br /> _Itnbu5on: Original—County <br /> Canary--Certified Private Applicator Pirk —Coay <br />