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1 <br /> ' PgUt SAN JOAQUIN COUNTY AGRICULTURAL COMMISSIONERS OFFICE <br /> 2101 E EARHART AVE,SUITE 100 <br /> ' w TMa STOCKTON, CA 95206 <br /> iYt r Office: (209) 953.6000 Fax: (209) 953-6022 <br /> o ,.• Email: stocktonag2@sjgov.org Web: www.co.aan-loaquln.ca.us/agcomm <br /> RESTRICTED MATERIALS PERMIT: 39-17-3904239 <br /> ' Operator:KOOYMAN, MIKE #3904239-2017-Version: 1 <br /> 22666 N MAY RD County District#:F I� <br /> ACAMPO,CA 95220 Issued on�T7 <br /> ' Valid as of�- —1,�Z. <br /> Expires on:12131121117 <br /> Primary Phone: <br /> Alternate Phone: <br /> Mobile Phone: <br /> Fax: <br /> ' Certified Applicator: KOOYMAN,MIKE Phone209-608-4716 <br /> 22666 N MAY RD License#:3998826 <br /> ACAMPO, CA 95220 Expiration:12131/2019 <br /> ' Type of Use:Agricultural Use <br /> Pesticide Possession: No Of Intent required hours prior <br /> Possession and Use to application of pesticide containing <br /> Permit Duration:Seasonal restricted materials <br /> ' Permit Condltlons:A,P, B,OL See condition detail for <br /> code descriptions. <br /> ' Site Conditions:GWP-R3 <br /> Regulatory Notes: <br /> ----------------------------- ------------------------------------- ------ <br /> ---- <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 on <br /> the issuance of Ills permit, I further understand that this permit may be 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 11108)Pesticide Enforcement Branch] <br /> KI /) <br /> Applicant: M ( �. <br /> ' (Name&Me) <br /> Applicant Sign u Date: '-/ 7 -1 7 <br /> ' Issuing Officer: Date: �/ f`/ - <br /> ' Page 1 <br />