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SAN JOAQUIN COUNTY <br /> 1868 E . HAZELTON AVENUE �� <br /> STOCKTON, CA 95205 <br /> Web URL : www . co , san-joaquin . ca . us/agcomm <br /> E-Mail : <br /> -Office : ( 209 ) 468-3300 Recorder (NOI ) : ( 209 ) 468-3300 FAX: ( 209 ) 468-3330 <br /> f ?STRICTED MATERIALS PERMIT PERMIT tt 39-02-3903245 <br /> County HQ District # : C <br /> VEENSTRA FARMING Expiration Date: 12/31/2002 <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 : 2095954278 <br /> 3,_z,r'mittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> Pr'ivate App IXI Seasonal IXI Poss & Use IXI Phone IXI Fax IXI <br /> t o Cert 1 1 Sob 1 1 Foss Only 1 1 Box IXI Modem I I <br /> ,,1 POO I I In Person IXI Web IXI <br /> Non-Ag I I NOI required 24 hours priorto application <br /> Non-Ag Use : None <br /> Conditions : PQWZ <br /> ------------- <br /> I understand that this permit does not relieve me from liability for any damage <br /> persons or property caused by the use of these pesticides . I waive any <br /> laim 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 /> aheling or in violation of applicable laws , regulations and specific <br /> onditions• 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 /> C7ounty Department of Agriculture of all areas treated or to be treated , storage <br /> acilities• for pesticides or emptied containers and equipment used or to be used <br /> 9 the treatment . [Ftyo--rm_ 1PR-EI•I7-125 (Rev . 07/92 ) Pesticide Enforcement Branch ] <br /> ermit Applicant : I�r' ! CkSY"to-, Sign : <br /> Title : r a r Issue Date : <br /> Issuinq Officer : A,' �"J7 Issue Date : <br /> Page 1 <br />