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E-mail: Office: (209)468-3300 RESTRICTED MATERIALS PERMIT ROZA,DAN 6800 S ROBERTS RD STOCKTON, CA 95206 - DAN ROZA - 6800 S ROBERTS RD STOCKTON, CA 95206 - Permittee `lupe: Private Applicator Permit 1"e: Seasonal Possession: Possession c& Use Conditions: A, P. Q, U See end of permit for code descriptions. SAN JOAQUIN COUNTY 1868 E. HAZELTON AVENUE STOCKTON, CA 95205 - Web: www. co. san-j oaquin. ca. uslagcomm Fax: (209}468-3330 Recorder (NOI's): (209)468.3300 2006 Permit Number: 39-06-3900396 County District #: I Expiration Date: December 31, 2006 Effective Date: I/ 1�7 /o Home Phone: (209)462-4906 Shop Phone: (209)462-6065 Mobile Phone: ( ) - Fax: NOI Method of Submission: Phone: X Fax: X Box: In Person: X Modem: Web: X NUI required 24 hours prior to application. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — I understand that this permit does not relieve me from liability for any damages to any persons or property caused by the use of these pesticides. I waive any claims of liability for damages against the County Department of Agriculture based on the issuance of this permit I further understand that this permit may be revoked when pesticides are used in conflict with the manufacturer's labeling or in violation of applicable laws, regulations and specific conditions of this permit I authorize inspection at all reasonable titres and whenever an emergency exists by the Department of Pesticide Regulation or the County Department of Agriculture of all areas treated or to be treated, storage facilities for pesticides or emptied ca-itainers and equipment used or to be used in the treatment- [ Fon-n reatment[Fonn PR-ENF-12.5 (Rev. 07192) Pesticide Enforcement Branch ] Penuit Applicant V,4 1 ft d Z (Please Print Title: C) �0 IAC F k_, (Please Print) Issuing Officert Issue Date: l 00 Issue Date: I