Laserfiche WebLink
STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATION <br /> PRIVATE APPLICATOR PESTICIDE ENFORCEMENT BRANCH <br /> CERTIFICATION STATEMENT <br /> PR-ENP-172(EST.7/91) <br /> CERTIFICATION EXPIRATION DATE <br /> PRIVATE APPLICATOR NAME APPLICATOR PHONE NUMBER <br /> T.¢ ELVAkb3 , <br /> ADDRESS <br /> L) <br /> CERTIFYING COUNTY NAME PERMIT NUMBER ISSUED COUNTY PHONE NUMBER <br /> off tel/ 3 13 el 67 Z//67- <br /> CERTIFICATION/PERMIT ISSUED BY: /^ TITLE <br /> L y <br /> CERTIFICATION ISSUED: <br /> GENERAL EXAMINATION El WORKER SAFETY EXAMINATION <br /> PESTICIDE SAFETY SERIES INFORMATION PROVIDED: PESTICIDE SAFETY SERIES INFORMATION(SERIES NUMBER(S)PROVIDED]: <br /> YES [—] NO <br /> I certify the above information is correct and that I have taken the Private Applicator Certification examination for the possession <br /> and/or use of restricted use pesticides. I have reviewed and understand questions answered incorrectly with the issuing county. <br /> CERTIFIED,PNIVA.TE APPLICATO IGNATU DATE SI ECVCERTIFIED <br /> Distribution: Original—County D / anary—CerofiedPrivateApplicator Pink —Copy <br />