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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 OFFICE <br /> 2101 E EARHART AVE, SUITE 100 <br /> STOCKTON, CA 95206 <br /> Office: (209)953-6000 Fax: (209)953 6022 <br /> ' e•, Email: stocktonag2@sjgov.org Web; +•�san.)oaquln.ca.us/agcomm <br /> 4c•u. . <br /> ' RESTRICTED MATERIALS PERMIT: 39-16-3904239 <br /> Operator:KOOYMAN,MICHAEL #3904239-2016-Version: 1 <br /> ' 22666 N. MAY RD. County District#:F <br /> ACAMPO,CA 95220 Issued on: <br /> Valid as of: <br /> Agent:MIKE KOOYMAN Expires on:12/31/2016 <br /> ' Primary Phone. <br /> Alternate Phone: <br /> Mobile Phone: <br /> ' Fax: <br /> Type of Use:Agricultural Use Notices Of Intent required 24 hours prior <br /> Pesticide Possession:Possession and Use to application of pesticide containing <br /> ' Permit Duration:Seasonal restricted materials <br /> Permit Condltions:A,P,B, QL See condition detail for <br /> code descriptions. - <br /> ' Site Conditions:GWP-R3 <br /> Regulatory Notes: <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 on <br /> ' the issuance of,this permit. I further understand that this permit maybe revoked when pesticides are used in conflict with <br /> the manufacturer's labeling or in violation of applicable laws, regulations, and specific conditions of this permit. I authorize <br /> Inspection at all reasonable times and whenever an emergency exists by the Department of Pesticide Regulation or the <br /> County Department of Agriculture of all areas treated or to be treated,storage facilities for pesticides or emptied <br /> ' containers and equipment used or to be used in the treatment. I have considered alternative and mitigation measures <br /> pursuant to Title 3,California Code of Regulations, section 6426. Taking Into account economic,environmental, social, <br /> and technological factors, I have adopted those that are feasible and would substantially lessen any significant adverse <br /> impact on the environment. <br /> ' [Form PR-ENF-125(Rev 11106)Pesticide Enforcement Branch] <br /> Applicant t K(?-. ©CJ + <br /> ' (Name&M10) <br /> Applicant Signa re--�-" Date: %-/f/��-/(�• <br /> ' Issuing Officer: — 'l Date: <br /> 1 <br /> ' Page 1 <br />
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