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Restricted Materials Permit Conditions Page#: 1 0£ 3 <br /> The Following Conditions Apply To Permit#: 39-03-3900391 <br /> ----------------------- ------------------------------------------------- - <br /> -- <br /> L ---WORMERS SAFETY SERIES ATTACHED <br /> -------------------- -------------------- <br /> CX] ------- <br /> _[Q-A-1-through A-9 General Info. ; [_] B-1 Cholinesterase Testing <br /> ---------------------------------------------------------------- -- <br /> PERMIT CONDITIONS ATTACHED <br /> y ----------------------- ---------------------------------------------------------- <br /> ` [X] P - General <br /> [X] a - Dicamba x Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> L [_] S Metam Sodium & Metam Potassium <br /> [_] T - Aldicarb (Temik) <br /> [_] U - Endosulfan (Thiodan) <br /> r_l V - Rice Peatirides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> [_] Attachments 1-9: Molinate (1,6) thiobencarb (2,6,7) , carbofuran <br /> L (3,6) , methylparathion (4,9) and malathion (voluntary: 5,8) <br /> W Meth <br /> [_] - yl Bromide <br /> [_] Soil within greenhouses <br /> [_] Commodity <br /> [_] Soil injection <br /> C_] Tarped potting soil <br /> [_] Single tree site <br /> ` [_] X - Furadan ehemigation of grapes <br /> [_] Z - Other <br /> PESTICIDE SALES: - GROUNDWATER PROTECTION=====_______________ <br /> L [n-The material I am purchasing will not be used in a Pesticide Management 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: f_] Atrazine [_] Simazine C_] Bromacil <br /> i <br /> [_] Diuron [_] Prometon [_] Bentazon <br /> I Certify under penalty of perjury that the foregoing statement is true, <br /> L and that I will not apply any material listed in Section 6800(x) 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 /> county agricultural commissioner or the director in a county in which <br /> 4 there is no commissioner. <br /> ------------- ------ <br /> Purchaser Date <br /> i <br />