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f RESTRICTED MATERIALS PERMIT continued . . . . . Page# : 3 <br /> L <br /> ZWART, REINA & JAMES Permit# : 39-02-3901435 <br /> L WORKERS SAFETY SERIES ATTACHED <br /> ----------------------------------------------------------------------------- <br /> I - [X]-A-1--through-A-9-General- Info. --_- [_]-B-1--Cholinesterase-Testing------ <br /> r <br /> ------------------------ ----------------------- <br /> PERMIT CONDITIONS ATTACHED <br /> L -------------------------------------—--------------------------------------- <br /> [X] P - General <br /> [X] Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> L [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) <br /> [_] T - Aldicarb (Temik) <br /> [_] U - Endosulfan (Thiodan) <br /> 6. [_] V - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> [_] Attachments 1-9 : Molinate (1 , 6) t.hiobencarb ( 2 , 6 , 7 ) , earbofuran <br /> r. (3 , 6) , methylparathion (4 , 9) and malathion (voluntary: 5 , 8) <br /> [X] W - Methyl Bromide <br /> L [_] Soil within greenhouses <br /> [_] Commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> [_] Single tree site <br /> [_] X - Furadan chemigation of grapes <br /> _ [_] Z - Other <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> L ------------------------------------------------------------------------------ <br /> [-kThe 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 /> L 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 <br /> copy of my restricted materials permit is attached. <br /> Material purchased: [_] Atrazine [_] Simazine (_] Bromacil <br /> Diuron [_] Prometon [_] Bentazon <br /> L 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 (x) 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 /> Y <br /> ---- - -(y��-- ------- a -� ---- <br /> '� Purc aser --- �� Dale l G <br />