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RESTRICTED MATERIALS PERMIT cont. Page 6 <br /> ARNAUDO, B & D Permit 4 : 39-99-3902007 <br /> WORKERS SAFETY SERIES ATTACHED <br /> -----------=------------------------------------------------------------------- <br /> ) A-1 through A-9 General Info . ; [_] B-1 Cholinesterase Testing <br /> ---------------------------------------------------- <br /> PERMIT CONDITIONS ATTACHED <br /> --------------7---------------------------------------------------------------- <br /> [X] P - General <br /> [X] Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_J R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam' <br /> [_J T - Aldicarb (Temik) <br /> [_J U - Endosulfan (Thiodan) <br /> [_J V - Rice Pesticides Program <br /> [_J Molinate (Ordram) Worker Safety <br /> [_] Attachments 1-9 : Molinate ( 1 , 6 ) thiobencarb (2 , 6, 7) , carbofuran <br /> ( 3 , 6 ) , methylparathion (4 , 9 ) and malathion (voluntary: 5 , 8 ) <br /> [_] W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> [_] Commodity <br /> [_J Soil injection <br /> [_] Tarped potting soil <br /> [_] Single tree site <br /> [_J X - Furadan chemigation of grapes <br /> [_] Z - Other <br /> ---------=-------------------------------------------=------------------------- <br /> ------------------------------------------------------------------------------- <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ------------------------------------------------------------------------------- <br /> [_] The material I am purchasing will not be used in a Pesticide Management <br /> Zone (as described in Section 6802 , Title 3 , California Code of Reg- <br /> ulations) for agricultural , outdoor institutional or outdoor industrial <br /> use . <br /> The material I am purchasing will be used in a Pesticide Management Zone <br /> (as described in Section 6802 , Title 3 , California Code of Regulations) <br /> for agricultural , outdoor institutional or outdoor industrial use anda <br /> copy of my restricted materials. permit is attached. <br /> Material purchased: [_J Atrazine [_J Simazine [_J Bromacil <br /> [_J Diuron [_J Prometon [_J Bentazon <br /> I Certify under penalty of perjury that the foregoing statement is true, <br /> and that I will not apply any material listed in Section 6800(a) in any <br /> Pesticide Management Zone for agriculture , outdoor institutional or <br /> outdoor industrial uses except in accordance with a permit issued by the <br /> county agricultural commissioner or the director in a county in which <br /> there is no commissioner. <br /> -------------------------- ------------------ <br /> Purchaser Date <br />