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ARNAUD,O, B & B Permit #: 39-97-3902007 <br /> WORKERS SAFETY SERIES ATTACHED <br /> --------------------------------------------------^-----------:--------------- - <br /> X] A-i through A-9 General Info. ; [J 8-1 Cholinesterase Testing <br /> ------ - - ---- -- - - -- - - -- - - - - - - - - - -- - - - - - - - - - - - - - - - -- - - - - - - - - - <br /> ----------------------------- <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X] P - General <br /> [X] 8 - Dicambs & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [J k - uicamba & Pnenoxys - Special Hazardous Area <br /> [,] S - Metam Sodium ('Vapam) - Sprinkler Irrigation Application <br /> [_] T - Aldicarb (Temik) <br /> [_] 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: 5,8) <br /> [� W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> [J Commodity <br /> [-1 Soil injection <br /> [_] Tarped potting soil <br /> [J Single tree site <br /> [ I X - Furadan chemigation of grapes <br /> [ 1 Z - Other <br /> ------------ <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> [ 1 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 /> [J 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 [J Simazine [_] Bromacil <br /> [ I Diurcn [.J Prometcn [_] Bentazon <br /> I Certify under penalty of perjury that the foregoing statement is true, <br /> and that 1 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 agrii:ultural eomirri55ioner or the director in a County in which <br /> there is no commissioner . <br /> Purchaser Date <br /> r <br />