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RESTRICTED MATERIALS PERMIT cont. Page 6 <br /> ARNAliDO, B & B Permit 4 : 39-99-3902007 <br /> ----------------- - ----------------------------------- <br /> --------- ----------------------------------------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> C-----------=----------------------------- ------------------------------ <br /> {] A-1 through A-9 General Info . ; [_j B-1 Cholinesterase Testing <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X] P - General <br /> [X] Q - Dicamba & Phenoxy Herbicides. - Central Valley/Hazardous Area <br /> [_] R - Dicamba & Phenoxyy-s - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) <br /> (_] T - Aldicarb (Temik) <br /> [_j L - Endosulfan (Thiodan) <br /> [_j V - Rice Pesticides Program <br /> [_j 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 /> [_] Commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> [_] Single tree site <br /> [_j X - Furadan chemigation of grapes <br /> [_] Z - Other <br /> -----------------------------------------------------=------------------ <br /> ----------------- ---------------------------------------------------------- <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ------------------------------------------------------------------------------- <br /> [_j 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 materialspermitis attached. <br /> Material purchased: (_] Atrazine [_] Simazine [_j Bromacil <br /> (_] Diuron [_1 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 on the director in a county in which <br /> there is no commissioner. <br /> -------------------------- ------------------ <br /> Purchaser Date <br />