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f1 L.! 1 fl1 M' 1 LV I Ifni <br /> r,RidAUi',t0, 8 & 8 Permit V 39-97-3902007 <br /> --------------------r__ WiJYtitL-RS SAFETY SERIES ATTACHED . <br /> - [-'1 A-1 through A=9-General-info. <br /> [-_o=1--C olinssterase- Testing------_ <br /> -^-----------~-+-------- PERMIT CONDITIONS ATTACHED <br /> [ri] <br /> h' - Gcilei'a <br /> [X] Q . - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [^j k - uicamba tic Phanoxys -- Special Hazardous Area <br /> [ I S - Metam Sodium (Vapam) - Sprinkler Irrigation Application <br /> [_] T - Aldicarb (Temik) <br /> [J U - Endosul'fan. (Thiodan) <br /> [_] V •- Rice Pesticides Program <br /> [� Moli.nate (Ordram) Worker Safety <br /> [_] ` t�iobencarb 2 6 7 carbofuran <br /> Attachments 1-9: Molinate �1 ,�) (� , <br /> - _ .. <br /> (3,6) , meti'lyl�'ial"aLi'11Vii (4,9)' and iTiaJ'.ai:illUi'1 (voluntary: S,3) <br /> [_] 'W - Methyl Bromide <br /> [ _] Soil within greenhouses <br /> [� commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> [J Single tree site <br /> [-,•] X - Furadan chemigation of grapes <br /> [_] Z - Other <br /> ESTICIDE SALES: GROUNDWATER PROTECTION <br /> - [_ ] - <br /> The-materi.al�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 /> [� <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 and a <br /> copy of my restricted materials permit is 'attached. <br /> Material purchased: [J Atrazine [_] Simazine [_] Bromacil <br /> [� Diuron Prometon [_] Rentazon <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 Lases 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 />