Laserfiche WebLink
...:ESTRICTED MATERIALS PERMIT continued '� Page#: 8 <br /> _ERRI & SON Permit# : 39-99-3900212 <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X] A-1 through A-9 General Info. I [_] 13-1 Cholinesterase Testing <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 /> [ J S - Metam Sodium (Vapam) <br /> [XJ T - Aldicarb (Temik) <br /> — [ ] U - Endosulfan (Thiodan) <br /> [_] V - Rice Pesticides Program <br /> [ J 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 /> [_] W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> [_] Commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> [_] Single tree site <br /> [_] X - Furadan chemigation of grapes <br /> [ J Z - Other <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 /> [ J 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: [_J Atrazine [_] Simazine [_] Bromacil <br /> [ ] Diuron [ J Prometon [ J 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 /> -------------------------- ------------------ <br /> Purchaser Date <br />