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I <br /> STATE OF CALIFORNIA ' <br /> PRIVATE APPLICATOR DEPARTMENT OF PESTICIDE REGULATiON <br /> PESTICIDE ENFORCEMENT BRANCH <br /> CERTIFICATION STATEMENT <br /> PR-ENF-172(EST.w9.1) <br /> CER7�FICAT JN EXPIRr <br /> ' PRIVATE APPLICATOR NAME (/ 3 L� <br /> z ` <br /> APPLICATOR PHONE NUMBER <br /> ADDRESS <br /> A CA t2 n C7 <br /> 9 D u rrn <br /> ' CERTIFYING COUNTY NAME PERMIT NUMBER ISSUED CO TY HONE N ER <br /> CERTIFiCATiON/PERMIT ISS7SAFETY-�� <br /> ' TITLE <br /> 1 CEFITIFIC LIED: <br /> GENERALE MI ATION n,tJORKER <br /> 3 �" <br /> PE TICIDE SAFETY SERIES INFORMATION PROViOED: P �ICJD ���ON(SERIES NUMBER(S)PROVIDED]: <br /> NO Ag� 41 <br /> 1 certify the above information is correct and that 1 have taken the Private Applicator Certification examination for the possession <br /> and/or use of restricted use pesticides. t have reviewed and understand questions answered incorrectly with the issuing county. <br /> F CERTIFIED PRI V APPLI TORS ATURE <br />' DATE SIGNED/CERTIFIED <br /> M Distribuflon: Ori in County ,. . <br /> 4 Canary—Certified Private Applicator } <br /> } <br /> { <br /> I <br />