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116:0 E HAZELTON AVENUE <br /> S.TOuO::•: hT, aA -152r5 <br /> Web ;.iPL' WWW. __ . Sari-]Oaqu_,_ . ca . ua'/agcomr1 <br /> i <br /> 7Y_ _= F.ecurder I+G . 191468 30Q t .py ; �68 33 <br /> P_-:STFICTED `�UaTERIALS PERMIT -_---_--____—-------------PEPhfIT 9 39-03-390.4826 <br /> County HP District 4 : G <br /> VITORIA PR=HERSExpiration Date: 12-31,/2003. <br /> 6686 W K.ILE RD Effective Date - f ice.. urj <br /> LODI, CA 55242- <br /> JOE VI TOR I.= Home : (203) 794-2531 <br /> 6686 W KILE PD Shop : ( 7 - <br /> LODI . CA 95242- Fax, <br /> Mobile <br /> Permittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> Private App I Seasonal IXI Pose & Use IXI Phone AXI Fax I I <br /> q A Cert I I Job I I Pose Only I I Box IXI Modem I I <br /> Ag PCG IXI In Person IXI Web I I <br /> Non-Ag I I NOI required 24 hours prior to application <br /> Non-Ag Use : None <br /> conditions : PQ <br /> I understand that this permit does not relieve me from liability for any damage <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 /> based 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 /> r, facilities for pesticides or emptied containers and equipment used or to be used <br /> in the treatment . [Form PR-ENF-125 (Rev. 07192) Pesticide Enforcement Branch] <br /> Permit Applicant : kw Sign : 40, k, � <br /> Title: Issue Date : 11 <br /> Issuingofficer: Issues Date: <br /> Page 1 <br /> IF <br />