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I4PTjtICTED MATERIALS PERMIT .cont. Page 4 <br /> r �3'ei PIIY RANCH Permit ; : 39-97-3903311 <br /> LWORKERS SAFETY SERIES ATTACiIED <br /> [X] A-1 through A-9 General 'Info.^ ; ] B-1 Cholinesterase Testing <br /> PERMIT CONDTTIONS ATTACHED <br /> --------------- <br /> [X] P - General <br /> L [X1 Q - Dicamba u Phenoxy Herbicides - Centra'_ Valley/IIasardous Area <br /> [_I R - Dicamba & Phenoxy� - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) - Sprinkler Irrigation Application <br /> [._l T - Aldicarh (Temik) <br /> i [_] U - End.osulfan (Thiodan) <br /> V - Rice Pesticides Program <br /> [_] Molinate (Ordram) worker Safety <br /> [`J Attachments 1-9 : Molinate ( 1 , 6 ) t.hiobencarb (2 , 6, 7 ) , carbofurar <br /> {:= , 6 ) , methylparathion (4, 9 ) and malathion (voluntary: 5 , 8 ) <br /> f Xj W - Methyl Isromide <br /> [;] Soil within greenhouses <br /> L [--] Commodity <br /> [._] Soil injection <br /> [ Tarped pr.,,tting soil <br /> [ Single tree site <br /> L [--I X Furadan chemigation of grapes <br /> [_) Z Other <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> �. t` .ae material I am purchasing will not be used in a Pe-.ticid-e Managemen . <br /> Zcnr (as described in Section 6802 , Title 3 , California Code of Reg- <br /> ulaticns ) for agricultural , outdoor institutional or outdoor industrial <br /> use. <br /> The material I an, purchasing will be used in a Pesticide Management Zone <br /> ( as described in Section 6802 , Title 3 , California Code of P.egulations ) <br /> for agricultural, outdoor institutional or outdoor industrial use and a <br /> copy of my restricted materials permitis attached. <br /> L Material purchased: [-_] Itra<ine [_] Simazine [_] L'romacil <br /> [-_] DiU.r Qn [_]- Yromc-tvr: L_] Dentazon <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( a) in .an <br /> Pesticide Management Zone for agriculture, outdoor institutional or <br /> outdoor industrial uses E<:cept in accordance with a permit issued by th'_ <br /> Lcounty agricultural commissioner or the director in a county in. which <br /> there is no commissiorei . <br /> 6. <br /> Purchaser Date <br /> L <br /> L <br />