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REST.RICTED MATERIALS PERMI cont. <br /> �j Page 4 <br /> � RIfv'AURO, LARRY <br /> Permit # : 39-99-3902083 <br /> i --------------- <br /> - <br /> -'--WORKERS_SAFETY SERIES ATTACHED <br /> ' -[a]-A_1 through A-9 General Info . - ; -[_1-B-1- Cholinesterase-Te` - - <br /> sting <br /> PERMIT CONDITIONS ATTACHED <br /> --------------------- <br /> --------------------- <br /> -------------------- <br /> X P - General <br /> [XI Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> ` [_) R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_) S - Metam Sodium (Vapam) <br /> ' [_l T - Aldicarb (Temik) <br /> [_) U - Endosulfan (Thiodan) <br /> [_l V - Rice Pesticides Program <br /> [_l Molinate (Ordram) Worker Safety <br /> [_1 Attachments 1-9: Molinate ( 1 , 6 ) thiobencarb ( 2, 6 , 7 ) , ' carbofuran <br /> ( 3 , 6) , methylparathion (4 , 9 ) and malathion (voluntary: 5 , 8 ) <br /> [h] W -- Methyl Bromide <br /> I_l Soil within greenhouses <br /> [_] Commodity <br /> [_I Soil injection M <br /> [_l Tarped potting soil �I <br /> [_] Single tree site <br /> ' <br /> 1.-1 h - Furadan ehemigation of grapes <br /> [_l Z - Other <br /> -------------�--===PESTICIDE <br /> _SALES : <br /> _ <br /> GROUNDWATER PROTECTION <br /> y -----------------_- ------------- <br /> ' <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 /> 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 F <br /> copy of my restricted materials permit is attached. <br /> Material purchased: - <br /> C_1 At razLne [—i Simazine [_] Bromacil <br /> [_l 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 /> ' there is no commissioner. <br /> -------------------------- ------------------- <br /> Purchaser Date � <br /> I <br /> A <br /> I <br /> A <br />