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Restricted Materials Per-it Conditions Page#: 1 of 2 <br /> The Following Conditions Apply To . . . . . . . . . . Permit#: 39-04-3904647 <br /> ----------------------------------------------------- <br /> WORRERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------- <br /> CX] A-1 through A-9 General Info. [_] B-1 Cholinesterase Testing <br /> ------------ ------------------------------------------------- <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> CX] P - General <br /> C_] Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> C_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> C_] S - Metam Sodium & Metam Potassium <br /> C_] T - Aldicarb (Temik) <br /> C_] U - Endosulfan (Thiodan) <br /> [_] V - Rice Pesticides Program <br /> C_] Molinate (Ordram) Worker Safety <br /> C_] Attachments 1-9: Molinate (1, 6) thiobencarb (2, 6,7) , carbofuran <br /> (3, 6) , methylparathion (4,9) and malathion (voluntary: 5,8) <br /> C_] W - Methyl Bromide <br /> C_] Soil within greenhouses <br /> C_] Commodity <br /> [_] Soil injection <br /> C-] Tarped potting soil <br /> C_] Single tree site <br /> C_] X - Furadan chemigation of grapes <br /> [X] Z - Other <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ------------------------------------------------------------------------------- <br /> [f] 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 /> - i <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 <br /> copy of my restricted materials permit is attached. <br /> Material purchased: [_] Atrazine C_] Simazine [_] Bromacil <br /> C_] Diuron C_] 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 /> Pesticide Management Zone for agriculture, outdoor institutional or <br /> outdoor industrial uses except in accordance with a permit issued by the <br /> ty agricultural commissioner or the director in a county in which <br /> the i commissioner. <br /> ---- - ��/---------------- <br /> Date <br /> - ------- <br /> Date <br />