Laserfiche WebLink
RESTRICTED MATERIALS PERMIT continued . . . . . Page# : 3 <br /> WOLTJER,, LARRY Permit# : 39-02-3903269 <br /> ------------------------------------------------------------------------------ <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------ <br /> ` (X] A-1 through A-9 General Info. ; -[_]-B_1--Cholinesterase-Testing-- <br /> ------------------------------------------------------------------------------ <br /> r ------------------------------------------------------------------------------ <br /> ----------PERMIT CONDITIONS ATTACHED <br /> ---------------- ----------------------------------------------- <br /> [X] P - General <br /> [X] Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> r (_j R - Dicamba & Phenoxys - Special Hazardous Area <br /> [_] S - Metam Sodium (Vapam) <br /> (_] T - Aldicarb (Temik) <br /> ` [_] U - Endosulfan (Thiodan) <br /> [_] V - Rice Pesticides Program <br /> (_] Molinate (Ordram) Worker Safety <br /> L [_J Attachments 1-9 : Molinate ( 1 , 6 ) thiobencarb ( 2 , 6 , 7 ) , carbofuran <br /> (3 , 6 ) , methylparathion ( 4 , 9 ) and malathion (voluntary: 5 ,8 ) <br /> [X] W - Methyl Bromide <br /> [_] Soil within greenhouses <br /> [_] Commodity <br /> [_J Soil injection <br /> [_] Tarped potting soil <br /> 111F Single tree site <br /> [_] X - uradan chemigation of grapes <br /> [_J Z - Other <br /> ------------------------------------------------------------------------------ <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> _ ------------------------------------------------------------------------------ <br /> [yQ,The material I am purchasing will not be used in a Pesticide Management <br /> Zone (as described in Section 6802 , Title 3 , California Code of Reg- <br /> ulations ) for agricultural , outdoor institutional or outdoor industrial <br /> use. <br /> [_] The material I am purchasing will be used in a Pesticide Management Zone <br /> (as described in Section 6802 , Title 3 , California Code of Regulations ) <br /> for agricultural , outdoor institutional or outdoor industrial use and a <br /> copy of my restricted materials permit is attached. <br /> Material purchased: [_] Atrazine [_j Simazine [_] Bromacil <br /> [_] Diuron (_J Prometon [_] Bentazon <br /> I Certify under penalty of perjury that the foregoing statement is true , <br /> and that I will not apply any material listed in Section 6800(a) in any <br /> Pesticide Management Zone for agriculture , outdoor institutional or <br /> outdoor industrial uses except in accordance with a permit issued by the <br /> county agricultural commissioner or the director in a county in which <br /> there is commissioner. <br /> ---�=%0 aim --- <br /> Purqaser Date <br /> V <br />