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Restricted Materials Permit Conditions Page#: 1 of 3 <br /> ..Phe Following Conditions Apply To Permit#: 39-06-3900137 <br /> ------------------------------------------------------------------------ <br /> IF <br /> WORKERS-SAFETY-SERIES-ATTACHED-- <br /> F---- -- _-______ <br /> [X] A-1 through A--9 General Info_ [_] B--1 Cholinesterase Testing <br /> ---_--__--------------------------------------------------- -_��__-______--------- <br /> --------------------- <br /> PERMIT CONDITIONS ATTACHED <br /> F�______________________________________________________________________________ <br /> [X] P - General <br /> [X] Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> C_] S -- Metam Sodium & Metam Potassium <br /> T - Aldicarb (Temik) <br /> [_] U - Endosulfan (Thiodan) <br /> C_] V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> [_] Attachments 1-9: Molinate (1,6) thiobencarb (2,6,7) , carbofuran <br /> 17 (3,6) , methylparathion (4,9) and malathion (voluntary: 5,8) <br />' 1j [X] W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> [_] Commodity <br /> [_] Soil injection <br /> {_] Tarped potting soil <br /> C_7 Single tree site <br /> [_] X - Furadan chemigation of grapes <br /> L [_1 Z - other <br /> "- PESTICIDE SALES: GROUNDWATER PROTECTION ---- <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 /> r. for agricultural, outdoor institutional or outdoor .industrial use and a <br /> } copy of my restricted materials permit is attached. <br /> Material purchased: [_ ] Atrazine C-] Simazine [_] Bromacil <br /> [_] 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 /> F 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 /> Fi there is no commissioner_ <br /> ------------------ <br /> F' Purchaser Date <br /> F <br /> F <br />