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SU0011567 SSCRPT
Environmental Health - Public
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SU0011567 SSCRPT
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Last modified
5/7/2020 11:35:15 AM
Creation date
9/6/2019 10:02:48 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSCRPT
RECORD_ID
SU0011567
PE
2622
FACILITY_NAME
PA-1700251
STREET_NUMBER
21379
Direction
N
STREET_NAME
MANN
STREET_TYPE
RD
City
ACAMPO
Zip
95220-
APN
01728009
ENTERED_DATE
11/6/2017 12:00:00 AM
SITE_LOCATION
21379 N MANN RD
RECEIVED_DATE
11/3/2017 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\M\MANN\21379\PA-1700251\SU0011567\SUR SUB RPT ADDENDUM.PDF
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EHD - Public
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SAN JOAQUIN COUNTY AGRICULTURAL COMMISSIONERS OFFICEi <br /> 1 0 <br /> 2101 E EARHART AVE, SUITE 100 <br /> i}a STOCKTON,CA 95206r ' <br /> w'$,. •`+ . Office: (209)953-6000 Fax: (209)953-6022 <br /> ' u.. Email: stocktonag2@sjgov,org Web: WWW. o.san-)oaquin.ca.uslagcomm <br /> ytr: •A <br /> ' RESTRICTED MATERIALS PERMIT: 39-15-3904239 <br /> Operator: KOOYMAN,MICHAEL #3904239-2015-Version: 1 <br /> 22666 N.MAY RD. County District#, F 1"— <br /> ' ACAMPO,CA 95220 Issued on: - <br /> Valid as of: <br /> Agent: MIKE KOOYMAN Expires on: 1 213 1/2 0 1 6 <br /> Primary Phone: <br /> Alternate Phone: <br /> Mobile Phone: <br /> ' Fax. <br /> Type of Use: Agricultural Use Nofices Of Intent required 24 hours <br /> Pesticide Possession: Possession and Use prior to application of pesticide <br /> Permit Duration: Seasonal containing restricted materials <br /> Permit Conditions: A.P,Q.B See condition detail for <br /> code descriptions, <br /> ' Site Conditions: GWP-R3 <br /> Regulatory Notes: <br /> ----------------------------- ---------------------------------------------------- ------------------------------------------------ <br /> ' I understand that this permit does not relieve me from liability for any damages to any persons or property caused by the <br /> use of these pesticides.I waive any claims of liability for damages against the County Department of Agriculture based <br /> on the Issuance of this permit. I further understand that this permit may be revoked when pesticides are used In conflict <br /> ' with the manufacturer's labeling or In violation of applicable laws, regulations,and specific conditions of this permit. I <br /> authorize inspection at all reasonable times and whenever an emergency exists by the Department of Pesticide <br /> Regulation or the County Department of Agriculture of all areas treated or to be treated,storage facilities for pesticides or <br /> emptied containers and equipment used or to be used In the treatment. I have considered alternative and mitigation <br /> ' measures pursuant to Title 3,California Code of Regulations,section 6426. Taking into account economic, <br /> environmental,social,and technological factors, I have adopted those that are feasible and would substantially lessen <br /> any significant adverse Impact on the environment. <br /> ' [Form PR-ENF•125(Rev 11106)Pesticide Enforcement Branch] <br /> Applicant: AA I iLe, 1 ot• tai?-f x 0 to N <br /> (Noma s ries) <br /> ' Applicant Signet �Z— ' y ---Dt.: /—Z� <br /> (p� <br /> Issuing Officer: 7 il. Date: T� 'I <br /> 1 . <br /> Page 1 <br />
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