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Restricted Materials Permit Conditions Page#: I of 3 <br /> The Following Conditions Apply To . . . . . . . . . . . _ _ . . . . . . Permit#: 39-03-3900062 <br /> WORKERS SAFETY SERIES ATTACHED <br /> - ----------------------------------------------------------------------------- <br /> �- 71 A-1 through A-9 General Info. [_ B-1 Cholinesterase Testing <br /> PERMIT~CONDITIONS�ATTACHED <br /> =___�.__�._�.__________----_____ <br /> - ------------------------------------------------------------------------------ <br /> [X1 P - General <br /> "LX] Qa - Dicamba & Phenoxy Herbicides - Central. Valley/Hazardous Area <br /> L R Dicamba & Phenoxys - Special Hazardous Area <br /> S - Metam Sodium & Metam Potassium <br /> 6W L_ 1 T - Aldicarb (Temzk) <br /> E_1 U -- Endosulfan (Thiodan) <br /> C_1 V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> EA Attachments 1-9: Molinate (1 ,6) thiobencarb (2,6,7 ) , carbofuran <br /> ON) , methylperathion (4,9) and malathion (voluntary: 5,S) <br /> 7] W - Methyl. Bromide <br /> �- [_1 Soil within greenhouses <br /> [_] Commodity <br /> C_] Sail injection <br /> ` C.-] Tarped potting soil <br /> [_] Single tree site <br /> L--] X - Furadan chemigation of grapes <br /> C_1 Z - Other <br /> ._ PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ------------------------------------------------------------------------------- <br /> C__.1 The material I am purchasing will not be used in a Pesticide Management <br /> �. Zane (as described in Section 6802, Title 3, California Code of Reg- <br /> ulations) for agricultural., outdoor institutional or outdoor industrial <br /> We, <br /> The material I am purchasing will be used in a Pesticide Management Zane <br /> 16' (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 /> LW <br /> Material purchased: [_] Atrazine C_] timazine [_] Bromacil <br /> [_] Diuron C_] Prometon L_1 Bentazon <br /> I 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 /> Purchaser irate <br />