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ESTRICTED MATERIALS PERMI =ont. Page 3 <br /> GOEHRING FARMS Permit #: 39-96-3904187 <br /> ------------ --------------------------- <br /> ---------------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> -----_------ <br /> ------------------- <br /> ---------------------------- <br /> -X] A-i through A-9 General Info. [_] B-1 Cholinesterase Testing <br /> --------------------------------------- <br /> ------------------- <br /> PERMIT CONDITIONS ATTACHED <br /> X] P General <br /> --------------------------------------------------------------- <br /> - <br /> C_] 0 - Dicamba & Phenoxy Herbicides - Central Valley/HazardoUs Area <br /> [_I R - Dicamba & Phenoxys - Special Hazardous Area <br /> C_] S - Metam Sodium (Vapam) - Sprinkler Irrigation Application <br /> C_] T - Aldicarb (Temik ) <br /> :X] U - Endosulfan (Thiodan ) <br /> V - Rice Pesticides Program <br /> C_] Molinate (Ordram) Worker Safety <br /> C_] Attachments 1-9: Molinate (1 ,6) thiobencarb (2,6,7) , carbofuran <br /> (3,6) , methylparathion (4,9) and malathion (voluntary: 5,8) <br /> [_] W - Methyl Bromide <br /> C_] Soil . within greenhouses <br /> C_] Commodity <br /> C_] Soil injection <br /> C_] Tarped potting soil <br /> C_] Single tree site <br /> _] X - Furadan chemigation of grapes <br /> C_] Z - Other <br /> -PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ---- ------------------------ <br /> The material I am urchasing will not be used-in a Pesticide Management <br /> Zone (as described in Section '6(302, Title 3, California Code of Reg- <br /> ulations) for agricultural , outdoor institutional or outdoor industrial <br /> use. <br /> L_] 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 <br /> C_] Bromacil <br /> C_] Diuron [_] Prometon [_] 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 /> Ztheis no commissioner. <br /> Purchaser ate <br />