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SAN JOAQUIN COUNTY zoos <br /> 1868 E. HAZELTON AVENUE <br /> STOCKTON, CA 95205- <br /> E-mai I: Web:www.co.ssn-joagtm,.caus/agcom-r, <br /> Office: (209)468.3300 Fax: (209)468.3330 Recorder(NOI's): (209)468.3300 <br /> RESTRICTED MATERIALS PERMIT <br /> COSTA INC,DAN Permit Number: 39-06-3901076 <br /> 1269 SPRING CREEK.DR Co»trty District#: B <br /> RIPON, CA 95366- Expiration Date: December 31, 2006 <br /> Effective Date: Apri17,2006 <br /> DAN R COSTA Horne Phone: (209)599-3567 <br /> 17608 E LOUISE AVE Shap Phone: (209) 234-2004 <br /> ES(ALON, CA 95320 ?Mobile Phone: (209)531-6135 <br /> Fax: (209) 234-2001 <br /> Petnvttee Type: Private Applicator NO!Method of Srrbalis-sion: <br /> Pennit Type: Seasonal Phone: X Fax: X Box: X <br /> Possession: Possession St.Use In Person: X Modem: X Web: X <br /> NOI required 24 howl prior to application. <br /> Conditions: A,P,Q <br /> Saa and ofpenmt fez <br /> code description¢. <br /> I-Linder-stand that this permit does not relieve me f t,m liability for any damage&,to any persons or property caused <br /> by the use of these pesticides. I waive any claims of liability for damages against the coin-,ty Departrnent of <br /> Agriculture based on the issuance of this permit I further understand that this permit may be revoked when <br /> pesticides are used in conflict with the manufacturer's labeling or in violation of applicable laws,regulations and <br /> specific conditions of this permit I authorize inspection at all reasonable times and whenever an emergency exists <br /> by the Depar<snent of Pesticide Re ation or the Count De partrnent of <br /> t3� Y E Agriculture of alI areas treated or to be, <br /> treated,storage facilities for pesticides or emptied containers and equipment used or to be used in the treatment. <br /> [Form PR-ENF-125 (Rev. 07192)Pesticide Enforcement Branch 1 <br /> Permit Applicant: Signed:- <br /> Title: <br /> igned:Tie: Issue Date: <br /> Issuing Office : Issue Date: -74 �U <br />