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V RESTRICTED MATERIALS PERAlffl( continued . . . . . Page##: _, <br /> CUNEO, ANGELO Permit#: 39-00-3900096 <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------- <br /> CX] A-1 through A-9 General Info. [-] B-1 Cholinesterase Testing <br /> PERMIT CGNDITIONS ATTACHED <br /> -----•-------------------------------------------------------------------------- <br /> LCX] P - General <br /> L"X] Q Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> C-] R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) <br /> LC_] T - Aldicarb (Temik ) <br /> {_] U Endoslllfan (Thiodan ) <br /> [_] V - Rice Pesticides Program <br /> C-7 Molinate (Ordram) Worker Safety <br /> LC_] Attachments 1-9: Molinate ( 1,6) thiobencarb (2,6,7) , carbofuran <br /> (3,6) , methylparathion (4,9) and malathion (voluntary: 5,S) <br /> 4 [X] W - Methyl Bromide <br /> LC-] Soil within greenhouses <br /> [_] Commodity <br /> [_7 Soil. injection <br /> [_] Tarped potting soil <br /> Single tree site <br /> [_] X - uradan chemigation of grapes <br /> [-] Z Other <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> " -------------------------------------------------------------------------------- <br /> Lj The material I am purchasing will not be used in a Pesticide Management <br /> �1 Zone (as described in Section 6802, Title 3, California Code of Reg-- <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 [_] Simazine C_] Bromacil <br /> C-] Diuron C_] Prometon C_] Bentazon <br /> r i Certify under penalty of perjury that the foregoing statement is true, <br /> and that I will riot apply any material listed in Section 6800(a) in any <br /> Pesticide Management Zone for agriculture, outdoor institutional or <br /> 6. county <br /> 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 /> - - -- ----- -J U <br /> GU--- <br /> Purchaser Date <br />