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DISTRIBUTION:ORIGINAL —COUNTY Slate of California <br /> 1ST COPY —APPLICATOR DEPARTMENT OF FOOD AND AGRICULTURE <br /> 2ND COPY—STATE INFORMATION SERVICES BRANCH <br /> _ MONTHLY SUMMARY PESTICIDE USE REPORT DATE SUBMITTED <br /> OPERATOR IFIR.A NAM EI COUNTY (WHERE APPLIEDI COUNTY NO MONTH/YR OFUSE NAME OF PERSON RESPONSIBLE FOR REPORT <br /> xk <br /> ADDRESS CITY 21P CODE <br /> SUBMIT ORIGINAL AND SECOND COPY TO THE <br /> COUNTY AGRICULTURAL COMMISSIONER <br /> PHONE IRESTRICTEDLINUMBER CENSE NUMBEN MATERIAL PERMITNOTOTAL NO. OF BY THE 10th OF THE MONTH FOLLOWING <br /> y�. APPLICATIONS �a THE APPLICATIONS. <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, cernetaries, 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—an pest control work performed by or under <br /> contract with State or local public eolth 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 Meosure) APPLICATIONS TREATED TREATED <br /> �v ins;•�>tis,'� � ,l4'��L'r�ir11/�'' <br /> LB OZ PT QT GA 0 <br /> L✓� '�s � ��� LB OZ PT QT �fA <br /> B OZ PT QT GA U <br /> 4 - - - <br /> LB OZ PT QT GA <br /> 5 <br /> LB OZ PT QT GA <br /> 6 - - - + <br /> LB OZ PT QT GA <br /> 7 LB OZ PT QT GA JAN 0 <br /> 8 - - - JOAQUIiv (;()U VTY. <br /> LB OZ PT QT GARj OF,AGR <br /> 9 <br /> LB OZ PT QT GA <br /> 10 <br /> LB OZ PT QT GA <br /> 39-060 (RE V,6/88) 8386016 <br />