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RESTRICTED MATERIALS PERMIT cont. Paye 5 <br /> ARNAUDO, B & B Permit # : 39-96-3902007 <br /> WORKERS SAFETY SERIES ATTACHED <br /> --------------------------------------------- <br /> ------------------------------ <br /> LX] A-1 through A-9 General Info. [� B-1 Cholinesterase Testing <br /> ------------ <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X] P - General <br /> [X] 9 - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [ I R - Dicamba & Phenoxys - Special Hazardous Area <br /> [ I S- Metam Sodium (Vapam)• - Sprinkler Irrigation Application <br /> [ I T - Aldicarb (Temik) <br /> [_1 U - Endosulfan (Thiodan) <br /> [ I V - Rice Pesticides Program <br /> [_] '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, S) <br /> ( 1 W - Methyl Bromide <br /> [_] Soil within, greenhouses <br /> [_3 Commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> [_] Single tree site <br /> f_] X - Furadan chemigation of grapes <br /> [� Z - Other <br /> ----------------------------------------------------------------------------- <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> (� 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 /> L_1 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 [ 1 Simazine [_] Bromacii <br /> [_] DiUron [_] Prometon [_7 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 agricultur- ommissioner or the director in a county in which <br /> there no issi er . <br /> J- -- -- - - -- -�- 0 Z ---- <br /> Purchaser Date <br />