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otc?g!(y e SAN JOAQUIN COUNTY AGRICULTURAL COMMISSIONERS OFFICE <br />2101 E EARHART AVE, SUITE 100 <br />.y <br />kg STOCKTON, CA 95206 <br />'. Office: (209) 953-6000 Fax: (209) 953-6022 <br />Email: stocktonag2@sjgov.org Web: www.co.san-joaquin.ca.uslagcomm <br />RESTRICTED MATERIALS PERMIT: 39-21-3905501 <br />Operator:BLAGG FAMILY FARMS <br />12630 ATKINSON RD. <br />Lodi, CA 95240 <br />Agent:TYLER BLAGG <br />Certified Applicator: BLAGG, TYLER S <br />12630 ATKINSON RD <br />LODI, CA 95240 <br />Type of Use:Agricultural Use <br />Pesticide Possession: Possession and Use <br />Permit Duration:Seasonal <br />Permit Conditions:Appendix C, Q. OL, R, P <br />Regulatory Notes: <br /># 3905501 -2021 -Version: 1 <br />County District ME <br />Issued on: 11/2612020 <br />Valid as of:11112021 <br />Expires on: 12/31/2021 <br />Primary Phone: _ <br />Alternate Phone: <br />Mobile Phone: <br />Fax: <br />PhoneE <br />License #:3911146 <br />Expiration: 12/31/2021 <br />Notices Of Intent required 24 hours prior <br />to application of pesticide containing <br />restricted materials <br />See condition detail for <br />code descriptions. <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. I waive any claims of liability for damages against the County Department of Agriculture based on <br />the issuance of this permit. I further understand that this permit may be revoked when pesticides are used in conflict with <br />the manufacturer's labeling or in violation of applicable laws, regulations, and specific conditions of this permit. I authorize <br />inspection at all reasonable times and whenever an emergency exists by the Department of Pesticide Regulation or the <br />County Department of Agriculture of all areas treated or to be treated, storage facilities for pesticides or emptied <br />containers and equipment used or to be used in the treatment. I have considered alternative and mitigation measures <br />pursuant to Title 3, California Code of Regulations, section 6426. Taking into account economic, environmental, social, <br />and technological factors, I have adopted those that are feasible and would substantially lessen any significant adverse <br />impact on the environment. <br />[Form PR-ENF-125 (Rev 11106) Pesticide Enforcement Branch) <br />Applicant: -j ,� 1 11t <� u� t -C- <br />- _( <br />&Til e) <br />Applicant Signature �5� �')`/ Date: > - Z.5 <br />Issuing Officer: Date: it -10 <br />Page 1 <br />