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RESTRICTED MATERIALS PERM-7 continued . . . . . Page#: 6 <br /> LODI FARMING INC Permit#: 39-01-3904309 <br /> --------------------------------------------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> - ------------------------------------------------------------------------------- <br /> [X] A-1 through A-9 General Info . C_] B-1 Cholinesterase Testing <br /> --------------------- -------------- <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X ] P - General <br /> CX] 0 - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> C_] S - Metam Sodium (Vapam) <br /> [_] T - Aldicarb (Temik ) <br /> [X] U - Endosulfan (Thiodan ) - <br /> C_] V - Rice Pesticides Program <br /> [_I Molinate (Ordram) Worker Safety <br /> [_] Attachments 1-9: Molinate ( 1 ,6) thiobencarb (2,6,7 ) , carbofuran <br /> (3,6) , methylparathion (4.9) and malathion (voluntary : 5,8) <br /> CX] W - Methyl Bromide <br /> [_I Soil within greenhouses <br /> [_I Commodity <br /> C_] Soil injection <br /> [_] Tarped potting soil <br /> C_] Single tree site <br /> [_] X - Furadan chemigation of grapes <br /> C_] Z - Other <br /> --- ------------------------ <br /> PESTICIDE SALES : GROUNDWATER PROTECTION <br /> ------------------------------------------------------------------------------- <br /> C)!9] The material I am purchasing will not be used in a Pesticide Management <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 /> [_] The material I am purchasing will be used in a Pesticide Management Zone <br /> (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 /> Material purchased : [_] Atrazine C_] Simazine C_] Bromacil <br /> [_] Diuron [_] Prometon C_] 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 /> Lag/ T--,421Nrn/G 1. `^nc <br /> `� <br /> ------------ <br /> Purchaser Date <br />