Laserfiche WebLink
! PEiTP C:T EC; Mt T- .'i _ - r <br /> IRINAURO , LARRY ' rerml.t # : <br /> WORi:ERS SAFETY SEPIES ATTACHED <br /> -_------------------------------- ------- <br /> [X] A-l . through A-9 Genera: Info _ CJ B- 1 Cholinesterase Testing <br /> i PERMIT CONDITIONS ATTACHED <br /> �. -----------------------------_---------------------------------------------------- i <br /> [X1 P - General <br /> [X] 0 - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R -- Dicamba & Phenoxys - Special Hazardous Area <br /> C_] S - Metam Sodium (Vapam) - Sprinkler Irrigation Application <br /> [_] T - Aldicarb (Temik) <br /> C_] U - Endosulfan (Thiodan) <br /> V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> [� Attachments 1-9: Molinate ( 1 , 6) thicbencarb (2 ,6 , 7) , carbofuran <br /> (3,6) , methylparathion (4 , 9) and malathion (voluntary : S , 8) <br /> [X] W - Methyl Bromide <br /> [_J Soil within greenhouses <br /> [_] Commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> [_] Single tree site <br /> [T] X -- Euradan chemigation of grapes i <br /> [� Z - Other <br /> _____ ___________ _____________________________________T_====__________ ___- i <br /> PESTICIDE SALES : GROUNDWATER PROTECTION <br /> ------------------------------------------------------------------------------- <br /> I [_] The materia? I arra purchasing will not be used in a Pesticide Managemen <br /> Zone (as described in Section 680: , Title 3 , California Code of Reg- <br /> ulations) for agricultural , outdoor institutional or outdoor industria'_ <br /> use. i <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 anc .a <br /> copy of my restricted materials permit is attached . <br /> Material purchased: Mtrazine [ 1 Simazine C_] Bromacii <br /> Cr; Diu ron [ -j Prometon [^] 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 ark, <br /> Pesticide manaaement Zone for agriculture , outdoor institutional or- <br /> outdoor inaustrial uses except in accordance with a permit issued by the <br /> county agricultural commissioner or the director in a county in whi4h <br /> there is no commissioner . <br /> --------- -- <br /> --------- ------ ------- <br /> PurchaserDate <br /> f <br /> ti <br />