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JILL(C-11.13/R-11.12/H-11.07/D-9.1 l User:Alpine Helicopters 4/17/20 11:34:44AM Version:7.7 <br /> STATE OF CALIFORNIA - ENVIRONMENTAL PROTECTION AGENCY <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PESTICIDE USE REPORT (33-025 Rev 3/90) PMIS 0033 <br /> V#M12-APL-00155-5 <br /> ( ) Nursery <br /> County Section Township Range Base&Meridian Method Permittee/Customer Applicator Name&Address <br /> 39 1 07 IS 8E M A Rob Norman ALPINE HELICOPTER SERVICE,IN( <br /> Operator Identification Number Site Identification Number Planted Area P.O.BOX 1405 <br /> 39-12-3901462 1-6 28.00 ac WOODBRIDGE,CA 95258 <br /> Location Block IDWheat <br /> S/Wildwood,E/Jack Tone <br /> Date/Time Applied Area Treated Commodity or Site Treated Crop ID <br /> Proposed:04/16/12 0841 Actual <br /> Actual: 04/16/12 1215 28.00 ac Wheat 29139-00 <br /> Restricted Chemical Registration Number Total Formulated Rate Per Dilution <br /> Material Number Product and Manufacturer From Label Product Used ac Volume <br /> Quilt Xcel 100.1324 2.80 12.80 10.00 <br /> UNIINOwN gal oz <br /> gal <br /> Days Reentry Days Preharvest I Application Supervised By NW N NE <br /> 12 hr day I Stephen Brunskill <br /> Environmental Changes/Comments <br /> W E <br /> Target Area <br /> fitted By: Date Time PCA Name <br /> SW S SE <br /> Joel Dozhier 4/17/201; 11:34 AM William Vignolo 8167 <br /> Received By: Box No. Date Time Approved <br /> Denied <br /> v OCT 1 0 <br /> ` pp <br /> • <br /> AN 1 S 2012 <br /> SAN JOAQ IINC)O TY <br />