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DISTRIBUTION:ORIGINAL -COUNTY State of California <br /> IST COPY -APPLICATOR DEPARTMENT OF FOOD AND AGRICULTURE <br /> 2ND COPY-STATE INFORMATION SERVICES BRANCH t / <br /> _ MONTHLY SUMMARY PESTICIDE USE REPORT DATE SUBMITTED <br /> OPERATOR IFIR.A NAME) COUNTY (WHERE APPLIED) COUNTY NO IMONTH/Y OFUSE NAME OF PERSON.RESPONSIBLE FOR REPORT <br /> ADDRESS ICITYZip <br /> CODE <br /> _ SUBMIT ORIGINAL AND SECOND COPY TO THE <br /> � COUNTY AGRICULTURAL COMMISSIONER <br /> PHONE NUMBER JLICEN:�E�EN RESTRICTED MATERIAL PERMIT NO. TOTAL NO. OF BY THE 10th OF THE MONTH FOLLOWING 06)L / �.�_ �Jc; �5�i APPLICATIONS THE APPLICATIONS. <br /> - COMPLETE COLUMNS A, B, C AND D FOR ALL USES - USE DEFINITIONS <br /> IF USE I5: CODE= IF USE IS: STRUCTURAL PEST CONTROL-any pest control work performed within or on <br /> buildings and other structures. This includes work done by a licensed <br /> -STRUCTURAL PEST CONTROL.............. 1 -COMMODITY FUMIGATION structural pest control operator. <br /> -LANDSCAPE MAINTENANCE.................. 3 -SPOT TREATMENT LANDSCAPE MAINTENANCE-any pest control work performed on landscape <br /> -RIGHT-OF-WAY........................................ 4 -SEED TREATMENT plantings around residences, or other buildings, golf courses, parks, school <br /> -PUBLIC HEALTH PEST CONTROL....... 5 -OTHER (AS PERMITTED BY grounds, cemetaries, etc. <br /> -VERTEBRATE PEST CONTROL ............ 8 THE COUNTY AG. COMM.) RIGHT-OF-WAY - any pest control work performed along or on roadsides, <br /> -REGULATORY PEST CONTROL............ 10 power lines, ditch banks and similar sites. <br /> TH EN: THEN: PUBLIC HEALTH PEST CONTROL-any pest control work performed by or under <br /> ENTER CODE IN COLUMN E • LEAVE COLUMN E BLANK <br /> contract with State or local public health or vector control agencies. <br /> • <br /> • LEAVE COLUMNS F & G BLANK • FILL IN COLUMNS F & G REGULATORY PEST CONTROL th any pest control work performed by public <br /> employees or contractors in the control of regulated pests. <br /> A B C D E F G <br /> MANUFACTURER AND REGISTRATION NUMBER FROM LABEL TOTAL PRODUCT USED NUMBER OF CODE COMMODITY OR SITE ACRES/UNITS <br /> NAME OF PRODUCT APPLIED INCLUDE ALPHA CODE (Circle One Unit of Measure)APPLICATIONS TREATED TREATED <br /> LB OZ PT QT GA <br /> ' LB OZ FIT QT GA <br /> 0/ LB OZ PT QT <br /> 4 <br /> LB OZ PT QT GA <br /> 5 <br /> LB OZ PT QT GA <br /> 6 <br /> LB OZ PT QT GA JE Clc-- a <br /> LB OZ PT QT GA ( r <br /> s - — — <br /> LB OZ PT QT GA AN JUAyUI►v u ulVTy <br /> DEPT, C <br /> 9 <br /> LB OZ PT QT GA <br /> 10 <br /> LB OZ PT QT GA <br /> 39-060 (REV.6/BBI B3 86026 <br />