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I <br /> STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATION <br /> PRIVATE APPLICATOR PESTICIDE ENFORCEMENT BRANCH <br /> CERTIFICATION STATEMENT <br /> I PR•ENF•172(EST.7191) CERTIFICATION EXPIRATION DATE <br /> I <br /> rt / <br /> PRIVATE APPLICATOR NAMEAPPL CATO PHONE NUMBER <br /> zC, ft 1 , ' 0 a 61 <br /> ADDRESS � (� <br /> VQ <br />+ CERTIFYING COUNTY NAME PERMIT NUMBER ISSUE��D// COUNTY PHONE NUMBER <br /> a r ri 90.2 i-Lj r�3/syp 7 <br /> CERTIFICATIO ERMIT ISSUED BY:R TITLE <br /> _ CERTIFICATION ISSUED: <br /> ❑ GENERAL EXAMINATION WORKER SAFETY EXAMINATION <br /> 1' <br /> - PESTICID AFETY SERIES INFORMATION PROVIDED: PESTICIDE SAFETY SERIES INFORMATION[SERIES NUMBER(S)PROVIDED]: <br /> y ES ❑ NO <br /> - !certify the above information is correct and that 1 have taken the Private Applicator Certification examination for the possession <br /> ti and/or use of restricted use pesticides. 1 have reviewed and understand questions answered incorrectly with the issuing county. <br /> CERTIFIED PRI VA APPL1 TOR SI TURES DATE SIGNEDJCERTIFIED i'# <br /> DisvibufiDn: igin CO3inty �- w F Canary.—cerpGed Private Applicalar <br /> _ x y .! <br /> i <br /> I <br /> I <br /> I <br /> I <br /> I <br /> i <br /> I. <br /> II <br /> V <br />