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STATE OF CALIFORNIA PESTICIDE <br /> OF PESTICIDE REGULATION <br /> PESTICIDE ENFORCEMENT BRANCH <br /> PRIVATE APPLICATOR <br /> -CERTIFICATION STATEMENT <br /> PR ENF-172(ESTIZI�l 1) CERTIFICATION EXPIRATION D <br /> �e,rwll-l-t-S : Fie yaks Rnn�,, M�rP� 2u„rl,,, 5-K Ra•,r� 11 - I <br /> PRIVATE APP�R NAME APPLICATOR PHONE NUMBER <br /> `ADDRESS 2�4, q 6e2��er 2c�, 5-1--o�k-{ten <br /> CERTIFYNG COUNTY NAME PERMIT NUMSERISS ED COUNTY NE NUMBER <br /> Zo A-QJ k� -17 .33a� <br /> —CERTIFICA ERMrrISS BV: TITL <br /> EZ <br /> MRTIFIEATIDN ISSUED' <br /> GENERALE INATION WORKER SAF TY E MINATION <br /> PESTICIDE SAFETY SERIES INFORMATION PROVIDED: PESTICIDE SAFETY SERIES INFORMATION(SERIES NUMBERS PROVIDED): <br /> YES 1:1 NO <br /> 1 certify the above information is correct and that 1 have taken the Private Applicator certification examination for the possession <br /> —and/or use of restricted use pesticides. I have reviewed and understand questions answered incorrectly with the issuing county. <br /> CERTFED PRIVATF/NIL�CATOTUBE DAIS SIGNE ERTIF <br /> Dia"ution: Oripind—Couny Canary—Certified PrNate Applicator Pink —cc" <br />