Laserfiche WebLink
..G'J.�'il.•.�t.+�.��1 P1 L11 ii.iLltlLi] ��n1`i.�.}�'VrV11UiA14l-\.r ba <br /> tLT <br /> 'OOR, SURGIT `:� Permit# : 39-02-3902192 <br /> WORMERS SAFETY SERIES ATTACHED <br /> ----------------- --- ------------------------- <br /> - <br /> [X] A-1 through-A-9R _ __ - - -- <br /> General Info . i -, B-1CholinesteraseM Testing . <br /> ------ PERMIT CONDITIONS ATTACHED <br /> -------------------------------------------------------------------------------- <br /> iXI P - General <br /> [X] Q - Dicamba & Phenoxy Herbicides -- Central Valley/Hazardous Area. <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> �_] S - Metam Sodium (Vapam) <br /> [-_] T - Aldicarb (Temik) <br /> [_I U - Endosulfan (Thiodan) F <br /> [_J `v' - Rice Pesticides Program <br /> [_I Molinate (Ordrarr) Worker Safety <br /> [_] Attachments 1.-9 : Molinate ( 1 , 6 ) thiobencarb ( 2 , 6 , 71 ) , carbofuran <br /> ( 3 , 6 ) , methylparathion ( 4 , 9 ) and malathion (voluntary: 5 , 8 ) <br /> [X] W - Methyl Bromide <br /> [_I Sail within gree nhouse.s <br /> ] ComrkoLA <br /> [_1 SGII 121�LCt3G11 <br /> [_I Tarped potting soil <br /> [_I Single tree site <br /> [_I X - Furadan chemigation of grapes <br /> [,,,_] Z - Other <br /> PESTICIDE-SALES: GROUNDWATER PROTECTION <br /> [_,,J The material- <br /> at eria.i-I- - - - r - - <br /> ampurchasingWillnot be used it la .Pesticide fianagement <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 /> [_I The material I am purchasing Will be used in a Pesticide Management Zone <br /> (as described in Section 6892 , 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 /> Material purchased: [_] . Atrazine [_] Simazine [_I Bromacil <br /> [_] Diuron [_I Prometon [_I 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 hermit issued by the <br /> county agricultural commissioner or thE: director in a county in which <br /> there is no commissioner. <br /> Pur'etiaser <br /> D a'Ll e <br />