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SAN JOAQUIN COUNTY 1868 E . HAZELTON AVENUE STOCKTON, CA 95205 Web URL:www. co.san-joaquin . ca . us/agcomm E-mail : r, Office : ( 209 ) 468-3300 Recorder (140I ) 1 ( 209 ) 468-3300 FAX: ( 209 )468-3330 ------------------------------------------------- RESTRICTED MATERIALS PERMIT PERMIT It : 39-04-3904929 ` County HQ District u : F AGUER NABORI PROPERTIES Expiration Date : 12/31/2004 ` 1211 L ST Effective Date : 01/08/2003 MODESTO, CA 95354- R.ADICE BOYSEN Home : ( 209 ) 524-2770 ` 1211 L ST Shop : ( 209 ) 748-5922 MODESTO, CA 95354- Fax: Mobile : ( 209 ) 604-8707 ------- --------------------- ----- ` Parmittee Type Permit Type Possession NOI Method of Submission -------------- -------------------------- Private App I I Seasonal IXI Ross & Use IXI Phone IX! Fax IXI g A Cert IXI Job I I Poss Only I I Box I I Modem IXj Ag PCO I I In Person IXI Web (XI Non-Ag I I NOI required 24 hours prior to application Non-Ag Use : None Conditions : P QAL 36585 I understand that this permit does not relieve me from liability for any damage to persons or property caused by the use of these pesticides . I waive any claim of liability for damages against the County Department of Agriculture based on the issuance of this permit . I further understand that this permit may be revoked when pesticides are used in conflict with the manufacturer 's labeling or in violation of applicable laws, regulations and specific conditions of this permit . I authorize inspection at all reasonable times and r whenever an emergency exists, by the Department, of Pesticide Regulation or the County Department of Agriculture of all areas treated or to be treated. storage facilities for pesticides or emptied containers and equipment used or to be used in the treatment . [Form PR-ENF-125 (Rev. 07/92 ) Pesticide Enforcement Branch] Permit Applicant : I"` ee- Sign : Title : AdL^ Issue Date . O Issuing officer : bzalnAAYIssue Date : �/ O - �, g e 1