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b urN o SAN JOAQUIN COUNTY AGRICULTURAL COMMISSIONERS OFFICE <br /> 2101 E EARHART AVE, SUITE 100 <br /> :.c STOCKTON, CA 95206 <br /> :. Office: (209)953-6000 Fax: (209) 953-6022 <br /> d�ifiogr'�P Email: stocktonag2@sjgov.org Web: www•co.san-joaquin.ca.us/agcomm <br /> RESTRICTED MATERIALS PERMIT: 39-12-3900040 L)-- AVIDXIGINAL <br /> Operator: BLOSSOM FARMS #3900040-2012-Version: 1 <br /> P 0 BOX 799 County District#: H <br /> LINDEN, CA 95236 Issued on: I`ri�0(D.j�� <br /> Valid as of: i j tq jaot2w <br /> Attention: RAJKOVICH,RANDALL Expires on: 12/31/2013 <br /> Home Phone: <br /> Office Phone. <br /> Mobile Phone. <br /> Fax. <br /> Type of Use: Agricultural Use Notices Of Intent required 24 hours <br /> Pesticide prior to application of pesticide <br /> Possession: containing restricted materials <br /> Permit Duration: Seasonal <br /> Employees Handle Pesticides <br /> Conditions: A, P, Q, O, W See condition detail <br /> for code descriptions. <br /> Regulatory Notes: <br /> --------------------------------------------------------------------------------------------------------------------------------------- <br /> I understand that this permit does not relieve me from liability for any damages to any persons or property caused by the <br /> use of these pesticides. 1 waive any claims of liability for damages against the County Department of Agriculture based <br /> on the issuance of this permit. I further understand that this permit may be revoked when pesticides are used in conflict <br /> with the manufacturer's labeling or in violation of applicable laws, regulations, and specific conditions of this permit. I <br /> authorize inspection at all reasonable times and whenever an emergency exists by the Department of Pesticide <br /> Regulation or the County Department of Agriculture of all areas treated or to be treated, storage facilities for pesticides or <br /> emptied containers and equipment used or to be used in the treatment. I have considered alternative and mitigation <br /> measures pursuant to Title 3, California Code of Regulations, section 6426. Taking into account economic, <br /> environmental, social, and technological factors, I have adopted those that are feasible and would substantially lessen <br /> any significant adverse impact on the environment. <br /> [Form PR-ENF-125(Rev /06 sticide Enforc "'en r nch] <br /> V <br /> Applicant: 6r,j �C/ C'C' <br /> (ha e!& r <br /> Applicant Signature: Date: 2- <br /> Issuing Officer: C Date: <br /> Page 1 <br />