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RESTRICTED MATERIALS PERMI' ontinued ..... Page#: 3 <br /> 'CARLSON, GARP Permit#: 39-03-3901062 <br /> ------------------------------------------------------------------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------ <br /> CX] A-1 through A-9 General Info. LJ B-1 Cholinesterase Testing <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> r <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> CXJ P - General <br /> CXJ Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> LJ R - Dicamba & Phenoxys - Special Hazardous Area <br /> LJ S - Metam Sodium (Vapam) <br /> LJ T - Aldicarb (Temik) <br /> LJ U - Endosulfan (Thiodan) <br /> r L] V - Rice Pesticides Program <br /> LJ Molinate (Ordram) Worker Safety <br /> LJ Attachments 1-9: Molinate (1,6) thiobencarb (2,6,7), carbofuran <br /> (3,6), methylparathion (4,9) and malathion (voluntary: 5,8) <br /> ` CXJ W Methyl Bromide <br /> LJ Soil within greenhouses <br /> LJ Commodity <br /> LJ Soil injection <br /> LJ Tarped potting soil <br /> L] Single tree site <br /> L] X - Furadan chemigation of grapes <br /> [XJ Z - Other <br /> ------------------------------------------------------------------------ <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ------------------------------------------------------------------------------- <br /> r. L] The material I am purchasing will not be used in a Pesticide Management <br /> Zone (as described in Section 6802, Title 3, California Code of Reg- <br /> ulations) for agricultural, outdoor institutional or outdoor industrial <br /> use. <br /> ` LJ The material I am purchasing will be used in a Pesticide Management Zone <br /> (as described in Section 6802, Title 3, California Code of Regulations) <br /> for agricultural, outdoor institutional or outdoor industrial use and a <br /> �- copy of my restricted materials permit is attached. <br /> Material purchased: [_J Atrazine [_] Simazine LJ Bromacil <br /> L-J Diuron [_J Prometon L] Bentazon <br /> I Certify under penalty of perjury that the foregoing statement is true, <br /> and that I will not apply any material listed in Section 6800(a) in any <br /> Pesticide Management Zone for agriculture, outdoor institutional or <br /> outdoor industrial uses except in accordance with a permit issued by the <br /> county agricultural commissioner or the director in a county III which <br /> �. there is no commissioner. <br /> -- -urchase-;-hase- <br /> Pr Date <br />