Laserfiche WebLink
STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATION <br /> PRIVATE APPLICATOR PESTICIDE ENFORCEMENT BRANCH <br /> CERTIFICATION STATEMENT <br /> PR-ENF-172(EST</�91) CERTIFICATION EXPIRATION D <br /> PRIVATE APP�R NAMES <br /> APPLICATOR PHCNE NUMBER <br /> J^tv <br /> y 48 - s x-93 <br /> ADDRESS <br /> ZS� q be•���� (Zd, S�cr��c-�-on <br /> CERTIFYING COUNTY NAME P RMIT NUMBER ISS ED COUNTY PHONE NUMBER <br /> a•, �o A-QJ <br /> CERTIFICA,j?)7ERMR ISSU BY: TITLE <br /> 1119 <br /> GO <br /> CERTIF ATION ISSUED <br /> GENERALE INATION WORKER SAF TY EX MINATICN <br /> ' PESTICIDE SAFETY SERIES INFORMATION PROVIDED: PESTICIDE SAFETY SERIES INFORMATION[SERIES NUMBENS PROVICEDI: <br /> YES E] NO !✓�1. <br /> I certify the above information is correct and that I have taken the Pnvate Applicator Certification examination for the possession <br /> and/or use of restricted use pesticides. I have reviewed and understand questions answered incorrectly with the issuing county. <br /> CERTIFIED PRIVA�CATO TURE DATE SIGNE^ ERT?FI <br /> Distribution: Original—County Canary—Certified Private Applicator Pink —Copy <br />