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;ESTI,I CTED MATERIALS PERMIT cont. sage <br /> ` 0EHR I NG FARMS Permit #: 59-97-5904137 <br /> WORKERS SAFETY SERIES ATTACHED <br /> --- - ------ <br /> [X] A-•1 throughA-9General Info. [_l B-1 Cholinesterase Testing <br /> PERMIT CONDITIONS ATTACHED <br /> -------------------- <br /> [X; P - General <br /> [_7 0 - Dicamba & Phenoxy Herbicides - Central ValleyiHacardou=. Area <br /> C_7 R - Dicamba & Phenoxys - Special Hazardous Area <br /> S - Metam Sodium (Vapam) - Sprinkler Irrigation Application <br /> C_7 T - Aldicarb (Temik ) <br /> [X,]. U - Endosul. fan (Thiodan ) <br /> C_1 V - Rice Pesticides Program <br /> C_7 Molinate (Ordram) Worker Safety <br /> C_7 Attachments 1-9: Molinate ( i ,6) thiobencarb (2, 6, 7) 9 ca.rbofuran <br /> (3,6) , methylparathion (4 ,9 ) and malathion (voluntary: 5,e) <br /> CX) W - Methyl Bromide <br /> 1_7 Soil within greenhouses <br /> [—I Commodity <br /> 1_7 Soil injection <br /> C_1 Tarped potting soil <br /> [_7 Single tree site <br /> C_1 X - Furadan chemigation of grapes <br /> 13 Z - Other <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> -- -----------------------------------•---- <br /> C 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 /> [_7 The material I am purchasing will be used in a Pesticide Management Zone <br /> (as described in Section 6eO , Title T , 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 [_I Simazine [_� lr-omacil <br /> [_I Diuron [_3 Prometon [ ] Bentacon <br /> T Certify under penalty of perjury that the foregoing statement is true, <br /> and that I will not apply any material listed in Section 6300(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 no commissioner. <br /> Purchaser � Date <br />