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SAN JOAQUIN COUNTY AGRICULTURAL COMMISSIONERS OFFICE <br /> _ tt 2101 E EARHART AVE, SUITE 100 <br /> Q.. M x2i <br /> a � � ' ;< STOCKTON, CA95206 _ <br /> Office: (209) 953.6000 Fax: (209)953-6022 <br /> oY P Email' stooktonag2@sjgov.org Web: www.aD.san-Ioaquln.ce.us/sgcomm <br /> RESTRICTED MATERIALS PERMIT: 39-17-3904239 <br /> Operator:KOOYMAN, MIKE #3904239-2017-Version: 1 <br /> 22666 N MAY RD County 1 District /y ACAMPO, CA 95220 Issued on?T7— f <br /> 5117EValid as 05117— <br /> Expires <br /> xpires on:12/31/2017 <br /> Primary Phone: <br /> Alternate Phone: <br /> ' Mobile Phone: <br /> Fax: <br /> Certified Applicator: KOOYMAN,MIKE Phone:209-608-4718 <br /> 22666 N MAY RD License 9:3998826 <br /> ACAMPO, CA 95220 Explration:12/31/2019 <br /> ' Type of Use:Agricultural Use <br /> 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 Condition:A,P,B,OL See condition detail for <br /> code descriptions. <br /> Site Conditions:GWP-R3 <br /> ' Regulatory Notes: <br /> 1 <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. 1 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 emptled <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, 1 have adopted those that are feasible and would substantially lessen any significant adverse <br /> Impact on the environment. <br /> ' (Form PR-ENF-125(Rev 11/08)Pesticide Enforcement Branch] n <br /> Applicant: M ( K e. o-Wh Pr ' <br /> (Name&TIOa) '.. <br /> ' Applicant Sign u Date; <br /> Issuing Officer Date: <br /> Page 1 <br />