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TESTRICTED MATERIALS PERMIT cont. Page 3 <br /> 30EHRING FARMS Permit Q 39-98-3904187 <br /> - -- -------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------- <br /> [X] A-1 through A-9 General Info. [_I B-1 Cholinesterase Testing <br /> PERMIT CONDITIONS ATTACHED <br /> ----------------------------------------------------------------- <br /> CX] P - General <br /> C_] 0 - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> C_3 S - Metam Sodium (Vapam) <br /> C_] T - Aldicarb (Temi.k: ) <br /> [X] U - Endosul•fan (Thiodan ) <br /> [_I V - Rice Pesticides Program <br /> C_] 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 /> C_3 W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> C_] Commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> C_] Single tree site <br /> C_] X - Furadan chemigation of grapes <br /> C_] Z - Other <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> -----------------------------------------------------------------------------•-- <br /> CIA 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 /> ula.tions) for agricultural , outdoor institutional or outdoor industrial <br /> use. <br /> C_7 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 : [_] Atrazine [_] Simazine [_] Bromacil <br /> C_7 Diur-on [_] Prometon C_] 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 commissi ner. <br /> �z Z' <br /> Z-7/2 <br /> Purchaser - <br /> Date <br />