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L ' 2003 � <br /> LSAN JOAQUIN COUNTY <br /> 1.868 E . HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> LWeb URL : www . co . san-joaquin . ca us:agcomm <br /> E-Mail <br /> --Office--( 209 ) 468__300---------Recorder- (NOI )-( 209 ) 468-3300-FAX: ( 209 ) 468-3330- <br /> RESTRICTED MATERIALS PERMIT PERMIT 4i 39-03-3900391 <br /> County HQ District 4 : H <br /> LROLLERS , VICTOR Expiration Date : 12131:200 <br /> `•113JE MAIN ST Effective Date .� <br /> STOCKTON, CA 95205 <br /> ,?J/gyp/ q <br /> VICTOR ROLLERI Horne . t209 )463-8486!! <br /> ` 5113 E MAIN ST Shop : <br /> L STOCKTON . CA 95205 Fax: <br /> Mobile ( 3 - <br /> Permittee Type Permit Type Possession NOI Method of Submission <br /> Private-App IXI Seasonal IXI Poss & Use IX{ - Phone IX1 Fax IXI <br /> Q A Cart, 1 1 ,lob I I Pose Only I I Box l I Modem IXI <br /> Ag PCO _ j In Person JX1 Web IXI <br /> Non-Ag <br /> ------) - I --------------------- -NOl-required-24-hours-prior-to-applicatial <br /> 1 Non-Ag Use: None <br /> L Conditions: PQ <br /> L I understand that Lila=== liabiisLy fol ally damage <br /> to persons or property caused by the use of these pesticides . I waive any <br /> claim of liability for damages against the County Department of Agriculture <br /> based on the issuance of this permit . I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacturer ' s <br /> labeling or in violation of applicable laws, regulations and specific <br /> conditions of this permit . I authorize inspection at all reasonable times and <br /> Lwhenever an emergency exists . by the Department of Pesticide Regulation or the <br /> 4 county Department of Agriculture Of all areas treated or to be treated, storage <br /> :acuities for peso^ides or emptied containers and equipment used or to be user <br /> in the treatment . .[Form PR-ENF-125 (Rev . 07.=92 ) Pesticide Enforcement Bran" <br /> J /q <br /> 6. Permit Applicant : j,[ j e---N - " 0 'fP- sign : <br /> Title : 67?1,Wo Issue Date : _ 3 <br /> L Issuing Officer : G. (/tom issue Date . - <br /> Page 1 <br /> V <br />