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SU0011567 SSCRPT (2)
Environmental Health - Public
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SU0011567 SSCRPT (2)
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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.PDF
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EHD - Public
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h, SAN JOAQUIN COUNTY AGRICULTURAL COMMISSIONERS OFFICE <br /> t °a� 2101 E EARHART AVE, SUITE 100 <br /> r' <br /> STOCKTON, CA 95206 <br /> Office: (209)953-6000 Fax: (209)953-6022 <br /> Email: stocktonag2@sjgov.org Web: www.co.san-)oaquln.ca,us/agoomm <br /> ° I <br /> i <br /> RESTRICTED MATERIALS PERMIT: 39-14-3904239 <br /> Operator: KOOYMAN,MICHAEL #3904239.2014-Version: 1 <br /> 22666 N. MAY RD. County District#: F <br /> ' ACAMPO, CA 95220 Issued on: <br /> Valid as of: / C-//gG <br /> ' Agent: MIKE KOOYMAN Expires on: 12/31/2014 GRIGU Primary Phone: <br /> IGI��AL Alternate Phone: <br /> ' Mobile Phone: <br /> Fax: <br /> Type of Use: Agricultural Use Notices Of Intent required 24 hours <br /> ' Pesticide Possession: Possession and Use prior a 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 /> - --------------- <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. 1 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 11/06)Pesticide Enforcement Branch] <br /> Applicant: K tS <br /> (Name&We) <br /> Applicant Signature. Date: <br /> Issuing Officer: - Date: <br /> ' Page 1 <br />
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