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SAN JOAQUIN COUNTY <br /> ,868 E. IIAZELTON AVENUE <br /> v°I`OCKTO1., C% 95205 <br /> ^ice: ( 209)468-3300 Recorder (NOI ) : (209 )468-3300 FAX: ( 209 )468-3330 <br /> RESTRICTED MATERIALS PERMIT PERMIT/OPERATOR I .D. #: 39-98-3903298 <br /> County IIQ District # : C <br /> I!. <br /> ;ENTENO, HECTOR xpiration4Dateeo-.:12/31/1998 <br /> Issue Dater`t <br /> _5997 S. SEXTON RD. <br /> ��p•-�� <br /> ESCALON, CA 95320- <br /> [ECTOR CENTENO Home: ( 209 )838-1434 <br /> 15997 S . SEXTON RD. Shop: ( 209 )838-1434 <br /> '?SCALON, CA 95320- Mobile: ( 209 )471-0435 <br /> FOR RESTRICTED MATERIALS PERMIT USE ONLY <br /> Permit Type: Foss. Only [ ] Seasonal [X] "'Poss. & Use [X] Job [ ] <br /> ?ermittee Type: Q.A. Cert [ ] Ag. PCO [ ] Private App [X] Non-Ag [ <br /> 10I required 24 hours prior to application. <br /> Method: Phone [X] Box [X] Person [X] Modem [ ] Fax [X] <br /> Jumb Pesticide=======Pests j Farm. tietuud( s) Applicator(s) <br /> --------------- ------------ -------- - <br /> 1051 SEVIN Larvae Liquid Air Ground PCO Grower <br /> L061 FURADAN Nematode Liquid Air Ground PCO Grower <br /> 2000 DICAMBA Weeds Liquid Air Ground PCO Grower <br /> 2001 BANVEL Weeds Liquid Ground PCO Grower <br /> 3830 METIIOMYL Larvae Liquid Air Ground PCO Grower <br /> 5540 STRYCIININE Gophers Bait Ground PCO Grower <br /> 7860 MCPA, DIMETIIYLA Weeds Liquid Air Ground PCO Grower <br /> 9801 2 ,4-D AMINE Weeds Liquid Ground PCO Grower <br /> 16011 PARAQUAT Weeds Liquid Air Ground PCO Grower <br /> 16891 SUPRACIDE Larvae Liquid Air Ground PCO Grower <br /> Jon-Ag Use: <br /> Conditions: PQ <br /> I understand that this permit does not relieve me from liability for any damage <br /> to persons or property caused by the use of these pesticides. I waive any <br /> claim of liability for damages against the County Department of Agriculture <br /> based on the issuance of this permit. I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacturer' s <br /> labeling or in violation of applicable laws, regulations and specific <br /> conditions of this permit. I authorize inspection at all reasonable times and <br /> Whenever an emergency exists, by the Department of Pesticide Regulation or the <br /> County Department of Agriculture of all areas treated or to be treated, storage <br /> facilities for pesticides or emptied containers and equipment used or to be <br /> used in the treatment. [Form 33-125/v3.53 (Rev. 02/16/90 ) P sticide Enforceme t <br /> Branch] <br /> Permit Applicant: <br /> �� � P��'� Sign: <br /> Title: 1/� 6f Date: /D CP� <br /> Issuing Officer: Date: <br />