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Y C <br /> SAN JOAQUIN COUNTY <br /> 1868 E. HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Office: . (209)468-3300 Recorder (NOI) : (209)468-3300 FAX: (209)46a-3330 <br /> RESTRICTED MATERIALS PERMIT .PERMIT/O.PERATOR I .D. #: 39-99-39b4929 ` <br /> County HO District #: F <br /> .. AGUn NABORI PROPERTIES Expiration Date: 12/31/2000 <br /> 915 17TH ST Issue Date: <br /> MODESTO, CA 95354- <br /> MIKE BURDEN Home: (209)524-2770 <br /> 915 17TH ST Shop: (2 , 3 F <br /> MODESTO, CA 95354- Mobile. <br /> -------------------------------------=---------------------- <br /> --------- ----------------------- ----- tf'�j ��® <br /> 17 <br /> FOR RESTRICTEDMATERIALSPERMIT USE ONLY - <br /> Permit Type: Poss . Only [ ] Seasonal [X] Pcss. & Use [X Job ] <br /> r. Permittee Type: B.A. Cert [ ] Ag. PCO C ] Private App CX; Non-Ag is ] <br /> NOI required 24 hours prior to application. <br /> Method: Phone [X] Box [X.] Person [X]' Modem [ Fax [X] <br /> ---------------------------------------------------------------------- -------- - <br /> Numb Pesticide Pest(s) Form. Method(s) Applicator(s) <br /> --�-- --------------- ------------ -------- ---------------- ----------------- <br /> 1051 SEVIN Larvae Liquid Ground PCO Grower <br /> 3831 LANNATE Larvae Liquid Ground PCO Grower <br /> 16011 PARAQUAT Weeds Liquid Ground PCO Grower <br /> Non Ag Use: <br /> Conditions : P <br /> I understand that thisliability for any damage <br /> permit does not relieve me from <br /> to 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 /> 6. rased on the issuance of this permit. I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacturer's <br /> labeling or in violation of applicable laws , regulations and specific <br /> ` conditions 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 <br /> used in the treatment . [Form 33-125/v3 .53 (Rev. 02/16/90) Pesticide Enforcement <br /> Branch] 2 <br /> r. Permit Applicant: t�l,�{�,` Sign: <br /> Title: 14nler7 Date : <br /> Issuing Officer : '� `� Date : <br />