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RESTRICTED MATERIALS PERMIT continued . . . . . Page#: 3 <br /> COLOMBINI FARMS Permit#: 39-00-3900084 <br /> ---------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X7 A-1 through A-9 General Info. [_1 B-1 Cholinesterase Testing <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X1 P - General <br /> [X] 0 - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_I R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_1 S - Metam Sodium (Vapam) <br /> [ 1 T - Aldicarb (Temik ) <br /> [-1 U - Endosulfan (Thiodan ) <br /> [-I V - Rice Pesticides Program <br /> [_1 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 /> [X1 W - Methyl Bromide <br /> [_1 Soil within greenhouses <br /> C_] Commodity <br /> _ [_1 Soil injection <br /> [_1 Tarped potting soil <br /> C�a Single tree site <br /> [_1 X - Furadan chemigation of grapes <br /> [_1 Z - Other <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 /> C_1 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: [_7 Atrazine C_] Simazine [_] Bromacil <br /> [_] Diuron C_7 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 68O0(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 /> Purchaser Date <br />