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SAN JOAQUIN COUNTY n <br /> 1868 E. HAZELTON AVENUE d��0 <br /> STOCKTON, CA 95205 <br /> Office: (209)468-3300 Recorder (NOI): (209)468-3300 FAX: (209)468-3330 <br /> --------------------------------------------------- <br /> RESTRICTED MATERIALS PERMIT Permit#: 39-01-3903245 <br /> County HQ District#: C <br /> VEENSTRA FARMING Expiration Date: 12/31/2001 <br /> 15863 S SEXTON Effective Date <br /> ESCALON, CA 95320- <br /> FRED VEENSTRA Home: (209)838-2894 <br /> 15863 S SEXTON Shop: (209)838-2894 <br /> ESCALON, CA 95320- Fax. <br /> Mobile: (209)404-3733 <br /> ------------------------------------------- <br /> ------------------------------- ------------------------------------ <br /> Permittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> Private App CX] Seasonal CX] Pose & Use CX] Phone VQ Fax CX] <br /> Q A Cert C I Job C I Poss Only C ] Box CX] Modem [X] <br /> Ag PCO C I In Person NO <br /> Nor.-Ag C I NOI required 24 hours prior to application <br /> ----------------------------- - <br /> ------------------------------------------------------------------------------- <br /> Numb Pesticide Pest(s) Form. Method(s) Applicator(s) <br /> ----- --------------- ------------ -------- ---------------- ----------------- <br /> 1051 SEVIN LARVAE Liquid Air Ground PCO Grower <br /> 1061 FURADAN NEMATODE Liquid Air Ground PCG Grower - <br /> 1360 CHLOROPICRIN NEMATODE Fumigant Ground PCO Grower <br /> 2000 DICAMBA WEEDS Liquid Air Ground PCU Grower <br /> 3141 GUTHION MITES Liquid Air Ground PCO Grower <br /> 38.30 METHOMYL LARVAE Liquid Air Ground PCU Grower <br /> 3850 METHYL BROMIDE SOIL/STORED Fumigant Ground PCO Grower" <br /> 4840 ALUMINUM PHOSPH RODENTS Fumigant Ground PCO Grower <br /> 5540 STRYCHNINE GOPHERS Bait Ground PCO Grower _ <br /> 7360 MC-PA, DIMETHYLA WEEDS Liquid Air Ground PCO Grower <br /> ****** PESTICIDES CONTINUED ON NEXT PAGE ****** <br /> Non-Ag Use: - <br /> Conditions: PQWZ <br /> ----------------------------------------------- <br /> ------------------------------------------------------------------------------- <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 revolved 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 /> facilities for pesticides or emptied containers and equipment used or to be used <br /> in the treatment. [Form PRS-ENF-125 (Rev. 07/92) Pesticide Enforrcc Qent Branch]" <br /> Permit Applicant: fD !r ECS 57 2}� Sign: <br /> Title: lTad s/= 2 Date: - <br /> Issuing Officer: Date: <br />