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SAN JOAQUIN COUNTY <br /> X868 E. HAZELTON AVENUF 20U <br /> STOCKTON,- CA 95205 <br /> Office: (20'9)468-3300 Recorder (NOI): (209)468-330(. FA)L (209)468-3330 <br /> •------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------- <br /> 4tESTRICTED MATERIALS PERMIT Permit#: 39-03-3901062 <br /> County HQ District#: B <br /> , ;ARLSON, GARY " Expiration Date: 12/31/2003 <br /> 19900 S JACK TONE RD Effective Date : O1�/2001 <br /> RIPON, CA 95366- 02 <br /> "GARY CARLSON Home: (209)599-3427 <br /> 19900 S JACK TONE RD Shop: ( ) <br /> UPON, CA 95366- Fax: <br /> .. Mobile: <br /> -------------------------------------------------------------------------=----- <br /> ------------------------------------------------------------------------------- <br /> -)ermittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> 015rivate App [X] Seasonal [X] Pose & Use OU Phone CX] Fax CX] <br /> Q A Cert [ ] Job C ] Pose Only C ] Box [X] Modem C ] <br /> ig PCO [ ] In Person CX] <br /> "Non-Ag C ] NOI required 24 hours prior to application <br /> ------------------------------------------------------------------------------- <br /> lumb Pesticide Pest(s) Form. Method(s) Applicator(s) <br /> r---- --------------- ------------ -------- ---------------- ----------------- <br /> 1360 CHLOROPICRIN NEMATODE Fumigant Fumigate PCO Grower <br /> 3850 METHYL BROMIDE SOIL/STORED Fumigant Fumigate PCO Grower <br /> 1840 ALUMINUM PHOSPH RODENTS Fumigant Fumigate PCO Grower <br /> X540 STRYCHNINE GOPHERS Bait Other PCO Grower <br /> 9801 2,4-D AMINE WEEDS Liquid Ground PCO Grower <br /> .6011 PARAQUAT WEEDS Liquid Ground PCO Grower <br /> --16891 SUPRACIDE LARVAE Liquid Air Ground PCO Grower <br /> Non-Ag Use: <br /> ,onditions: PQWZ <br /> understand that this permit does not relieve me from liability for any damage <br /> -zo persons or property caused by the use of these pesticides. I waive any <br /> claim of liability for damages against the County Department of Agriculture <br /> used on the issuance of this permit. I further understand that this permit <br /> nay be revoked when pesticides are used in conflict with the manufacturer's <br /> .labeling or in violation of applicable laws, regulations and specific <br /> :onditions of this permit. I authorize inspection at all reasonable times and <br /> 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 <br /> facilities for pesticides or emptied containers and equipment used or to be used <br /> Ln the treatment. [Form PR-ENF-125 (Rev. 07/92) Pesticide Enforcement Branch] <br /> ( � <br /> Permit Applicant: n!�4 Qmw I zNxn Sign: <br /> Title: Date: "�� <br /> Issuing Officer: Date: 011evIr.21 <br />