Laserfiche WebLink
'RINr,UR0 , LARRY - <br /> mi 39-98-3902083 <br /> 083 <br /> i WORKERS SAFETY SERIES ATTACHED - - - <br /> ---------------------------------------- <br /> � (�] Info . ' ------------------------- <br /> A-i through A-9 General I [ ] B-1 Cholinesterase Testing <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------ <br /> 1XJ' P - General <br /> IM Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area - <br /> (_] R - Dicamba & Phenoxys - Special Hazardous area <br /> [_] S - Metam Sodium (Vapam) <br /> [_] T - Aldicarb (Temik) <br /> (_] U - Endosulfan (Thiodan) <br /> [_] V - Rice Pesticides Program <br /> C_] Molinate (Ordram) Worker Safety <br /> { [_] Attachments 1-9 : .Molinate ( 1 , G ) thiobencarb ( 2 , 6 , 7 ) , carbofaran <br /> ( 3 , 6 ) , methylparathion ( 4 , 9 ) and malathion (voluntary: 5 , 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 /> [_] h - Furadan chemigation of grapes <br /> r [ _] Z - Other <br /> PESTICIDE SALES : GROUNDWATER PROTECTION <br /> ------------------------------------------------------------------------ -------- <br /> 4 <br /> [_J she 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- H <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 s <br /> copy of my restricted materials permit is attached . <br /> S <br /> Material purchased: [_] Atrazine [_J Simazine [_] Bromacil <br /> [_J Diuron [_J Prometon [_J Bentazan <br /> M <br /> I Certify under penalty of perjury that the foregoing statement is true , ) <br /> r <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 /> yy,, ------------------ <br /> 1 ---- <br /> Purchaser Date <br /> DatC <br />