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SAN JOAQUIN COUNTY 1868 E. HAZELTON AVENUE STDCKTON, CA 95205- E-mail' Web:www.co.san•joaqu:si ca.uslagcomm Office: (209)468.3300 Fax: (200)468.3330 Recorder(Nora): (209)468.3300 RESTRICTED MATERIALS PERMrr COSTA INC,DAN Permit Number. 39-04-3901076 1269 SPRING CREEK DR ComuS'District#: B RIPON, CA 95366- Expiration Date: December 31, 2004 Effective Date: Jarmaryl), 2004 DAN R COSTA Home Phone: (209)599-3567 17608 E LOUISE AVE Shop Phone: (209) 234-2004 E.SCALON, CA 95320 Mobile Phone: (209)531-6135 Far. (209) 234-2001 Permittee Type: Private Applicator NOI Method of Submission Permit Type: Seasonal Phone: X Fax X Box: X Possession: Possession&Use In Person: X Modem: Web: x NOI required 24 hours prior to application. Conditions: A,P,Q See end of permit for code descriptions, — — — — — — — — — — — — — — — — — — — — — — — — — — — I understand that this permit does not relieve me from liability for any damages to any persons or property caused by the use of these pesticides. I waive any claims of liability for damages against the County Departnt+n t of Agriculture based on the issuance of this permit. I further understand that this permit may be revoked wihen pesticides are used in conflict with the manufacturer's labeling or it,violation of applicable laws,regulations and specific conditions of this permit I authorize inspection at all reasonable times and whenever an emergency exists by the Department of Pesticide Regulation or the County Department of P4riculture of all areas treated or to be treated,storage facilities fin•pesticides or emptied containers and equipment used or to be used in the treatment. [Form PR-E17-125 (Rev. 07!92)Pesticide Enforcement Branch] Permit Applicant`\ �o�..� � ��Cy Sigpe . P ease P Title: Issue Date: J 1 p y ase Print) '�— Issuing Officer: Issue Date: ' —710