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DISTRIBUTION:ORIGINAL —COUNTY State of California <br /> 1ST COPY —APPLICATOR DEPARTMENT OF FOOD AND AGRICULTURE <br /> 2ND COPY—STATE INFORMATION SERVICES BRANCHf� � q <br /> _ MONTHLY SUMMARY PESTICIDE USE REPORT DATE SUBMITTED / <br /> OPERATOR (FIR,A NAME) -� COUNTY IWHERE APPLIED) ICOUN I NO jM11"T1/yFyOFUSE NAME OF PERSON RESPONSIBLE FOR REPORT <br /> ADDRESS CITY ZIP CODE <br /> SUBMIT ORIGINAL AND SECOND COPY TO THE <br /> - J COUNTY AGRICULTURAL COMMISSIONER <br /> PHONE NUMBER LICENSE CEN -( ER RESTRICTED MATERIAL PERMIT NO. TOTAL NO. OF BY THE 10th OF THE MONTH FOLLOWING <br /> -��,7 , �`��� �""` �y U1�,���� ��� APPLICATIONS THE APPLICATIONS. <br /> v 7 <br /> - COMPLETE COLUMNS A, B, C AND D FOR ALL USES - USE DEFINITIONS <br /> IF USE IS: 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, cemeteries, 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 /> THEN: THEN: PUBLIC HEALTH PEST CONTROL-an pest control work performed by or under <br /> contract with State or local public health or vector control agencies. <br /> • ENTER CODE IN COLUMN E • LEAVE COLUMN E BLANK REGULATORY PEST CONTROL — any pest control work performed by public <br /> • LEAVE COLUMNS F & G BLANK • FILL IN COLUMNS F & G 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 /> � <br /> LB OZ PT QT QGA <br /> 2 <br /> LB OZ PT Q G <br /> 3 <br /> LB OZ PT QT GA <br /> 4 <br /> LB OZ PT QT GA <br /> 5 <br /> LB OZ PT QT GA <br /> 6 - - - EIV <br /> LB OZ PT QT GA <br /> I IL <br /> 7 LB OZ PT QT GA J N 10 M5 <br /> 8 _ _ _ SAN J AQUIN COUNTY, <br /> LB OZ PT QT GA pEff, Of, AGIR."IRAQ% <br /> 9 <br /> LB OZ PT QT GA <br /> 10 <br /> LB OZ PT QT GA <br /> 39-060 (REV.6/88) 93W026 <br />