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�- RESTRICTED MATERIALS PER410f continued . . . . . �./ Page# : 6 <br /> LODI FARMING INC Permit#: 39-00-3904309 <br /> ----------------------- -------------------------------------- <br /> --_____---- -------------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> -----------------------------—------------------------------------------------ <br /> ------------------------------------------------------------------------------- <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> L [X] 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 /> L [_] T - Aldicarb (Temik) <br /> [X] U - Endosulfan (Thiodan) <br /> [_] V - Rice Pesticides Program <br /> [_J Molinate (Ordram) Worker Safety <br /> L (_] Attachments 1-9: Molinate ( 1 , 6 ) thiobencarb (2 , 6 , 7 ) , carbofuran <br /> ( 3, 6) , methylparathion (4 , 9 ) and malathion (voluntary : 5 , 8) <br /> L [XJ W - Methyl Bromide <br /> [_J Soil within greenhouses <br /> [_] Commodity <br /> L [_] Soil injection <br /> [_] Tarped potting soil <br /> (_] Single tree site <br /> [_] X - Furadan chemigation of grapes <br /> [_] Z - Other <br /> ------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------- <br /> -------PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ------------ ---------------------------------------------------- <br /> 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 [_] Simazine [_] Bromacil <br /> [_] Diuron [_] Prometon [_] 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 /> LflD 1 r-A j2)4 iNg,Xfi c. <br /> V "Purchaser Date <br />