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_ SAN JOAQUIN COUNTY I <br /> 1868 E. HAZELTON AVENUE <br /> STOCKTON CA 95205 F <br /> Office: ( 209)468-.3.300 Recorder (NOT ) : ( 209.)468-33b,. FAX:. ( 209 )468-3330 <br /> RESTRICTED MATERIALS PERMIT PERMIT/OPERATOR I .D. #�.: 39-98-3902102 <br /> County HQ District # : J <br /> Ia nl h �' Expiration...Date ; 12/31/1999 <br /> 1375 JAMIE DRIVE Issue Date ; 01/10/199$ <br /> YUBA CITY, , CA 95993 <br /> SURGIT TOOR Home : ( 530 ) 751.-9347 1 <br /> 627 W. VERNALIS ROAD Shop: ( 530 ) 751-9347 <br /> TRACY, CA, CA 95376 . Mobile; ( } - <br /> __.. FOR RESTRICTED MATERIALES- PERMIT USE ONLY <br /> Permit Type; Poss. Only [ ] Seasonal [X] Poss. & Use [XI Job [ ] <br /> Permittee Type; Q.A. Cert [ j Ag . FCO [ ] Private APA [X] Non--Ag [ j <br /> NOI required 24 hours prior to application. <br /> xlethod: Phone [ZX'] Boy: [ ] Person [ ] Modem [ ] Fax [ j <br /> Numb Pesticide Pest( s ) Form. Method( s ) Applicator( s) <br /> _____ ------ ------ ------------ -------- ---------------- ----------------- <br /> 1051 SEVIN Larvae Liquid Air Ground PCO Grower <br /> 1360 CHLOROPICRIN Nematode Fumigant Ground PCO Grower <br /> 3850 MET14YL BROMIDE Soil/Stored Fumigant Ground PCO Grower <br /> 9801. 2 , 4-D AMINE Weeds Liquid Ground PCO Grower <br /> 16011 PARAQUAT Weeds Liquid Air Ground PCO Grower <br /> 16891 SUPRACIDE Larvae Liquid Air Ground PCO Grower <br /> s <br /> i <br /> Non-Ag Use: <br /> Conditions: PQW <br /> I-understand that this permit-does notrelieveme from liability for any damage <br /> to persons or property caused by the use of these pesticides . I waive any <br /> claim of liability for damages against the County Department of Agriculture <br /> based on the issuance of this permit . I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacturer' s <br /> labeling or in violation of applicable laws ,, regulations and specific ; <br /> conditions of this permit. I authorize inspection at all reasonable times and � <br /> whenever an emergency exists , by the Department of Pesticide Regulation or the <br /> County Department of Agriculture of all areas treated or to be treated, storage <br /> facilities for pesticides or emptied containers and equipment used or to be <br /> used in the treatment . [Form 33-125/v3 . 53 (Rev. 0.2/16/90 ) Pesticide Enforcement <br /> Branch] <br /> Permit Applicant- (owl, Sign- IpC) <br /> Title : Date : <br /> jw- <br /> Issuing Officer: Date : <br /> � w �� s <br />