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Ilrl'1'.bir,le3L5 }-'hi-Lrii'1' CGnu;3rtuG4 <br /> :hNikUDO ,. B & B Permit' . 39-00-380200"1 <br /> WORKERS "SAFETY SERIES ATTACHED ' <br /> [X ^A-1- trough A-8 General info . <br /> � _Cho'line.steraserTesting <br /> � � <br /> ------------ <br /> - <br /> - <br /> -__---_ <br /> f <br /> PERMIT COI�FDITICNS ATTACHED <br /> _ _-------------------- <br /> _----------------- -_- ___----__----------- ----�---- ---- <br /> [ti] r7 General .. . <br /> '.. <br /> ��,� @ - Dicamba .FhenoAy Herbicides _,- ' Central Valley/Hazardous Area <br /> . `nreaR icam3a.. & PhenoyS : j <br /> LTl �S Metam Sodium :(.Vapam) <br /> L!} T -. rildicarb (Temik) <br /> [_] U -E.n'osulfan. (Thioda:n) . <br /> L_3 v Rice: Pesticides PragrsM , <br /> L_7 Molina.te (Ordram). 1 arker. Safety <br /> [] 'Attachments 1-0 : .Molinate ( 1 , 6 ) thiobenc' 6rb ( 2 , 6 , 7`) , carbofuran <br /> methylparathion (4 , 9)L and ..malathion (voluntary: 6, , 8 ) <br /> �' <br /> T. �,_�h 3 Bromide <br /> �4Le , <br /> [_] Soil. within . greenhouses. <br /> L_ l Commodity <br /> L_ So.il .injection <br /> Tarped potting soil <br /> [_7 Single tree. Sita <br /> L_] X -Furadan chemi-gation of grapes <br /> [_] -' Other <br /> _ ____ ___________________ .---__-_______-__--- .�_------------------- <br /> ----------------- <br /> - _ <br /> PESTICIDE SALES : GROUNDWATER PROTECTION. <br /> --__ T __ --- --- --------- -- ------------- . ------- ------------------- - <br /> _ <br /> [_] The material .I am purchasing will not be used in a Pesticide .Management <br /> -Zone' ( as described in Section .6,802 ,. Title '3 , California Code of Reg- <br /> ulations ) for agricultural,''- outdoor . nstitutional or outdoor industrial <br /> use . <br /> [�] The;, material I am purchasing will be ' used. in a Pesticide Manageinent'• Zone` <br /> ( as. described iri Section� 6802 , 'Title 3 , CaliforniaCoale 6 Reg;alations ) <br /> for.'agricultural , outdoor institutional or outdoor industrial use and :a <br /> copy of- my restricted materials Permit is- attached: ' <br /> Material purchased ['_] Atrazi.ne Simazihe [�]. Br.omacil <br /> E-} Di.uron ' L_7 :Prometon L i •.Bentazozi . <br /> I, -Certify under :penal.ty of perjury that , the foregoing statement is true , <br /> and that.- I .will not. apply any material Iisted in .Section. 6800(a) in any <br /> .-Pesticide Management Zone ..for agriculture, . outdoor. ,institutiona.l or <br /> outdoor industrial uses .except in accordance with a .permit issued by the, <br /> county" agr.icultural commissioner or the: director in a .county` in which <br /> :there is no commissioner. <br /> ---- - - ---------------------- -_- <br /> ------ --__ - -_ <br /> Purchaser Date <br />