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r, Restricted Materials PO%elit Conditions lft� Page#: 1 of 4 <br /> The Following Conditions Apply To . . . . . . . . . . . . . . . . . . . . . . Permit#: 39-03-3904309 <br /> -------------- ----------------------------------------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X1 A-1 through A-9 General Info. : [_1 B-1 Cholinesterase Testing <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> ` PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X] P - General <br /> [X] Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_7 S - Metam Sodium & Metam Potassium <br /> [_7 T - Aldicarb (Temik) <br /> [X7 U - Endosulfan (Thiodan) <br /> [_1 V - Rice Pesticides Program <br /> [_1 Molinate (Ordram) Worker Safety <br /> [_1 Attachments 1-9: Molinate (1,6) thiobencarb (2, 6,7) , carbofuran <br /> ` (3,6) , methylparathion (4,9 ) and malathion (voluntary: 5,8) <br /> CX1 W - Methyl Bromide <br /> C_7 Soil within greenhouses <br /> [_1 Commodity <br /> [_1 Soil injection <br /> [_1 Tarped potting soil <br /> [_1 Single tree site <br /> [_I X - Furadan chemigation of grapes. <br /> [X7 Z - Other <br /> -------=--------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> _____--- ------- <br /> -------------- -------------------------------------------------- <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ------------------------------------------------------------------------------- <br /> -EA1 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: [_7 Atrazine [_J Simazine C_J Bromacil <br /> C_7 Diuron [_1 Prometon C_1 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 /> ther is no commissioner. <br /> Purchaser Date <br /> L <br />