Laserfiche WebLink
Restricted Materials Permit Conditions Page#: 1 of 3 <br /> The Following Conditions Apply To Permit#: 39-02-3903245 <br /> ------------------------------- <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [X] A-1 through A-9 General` Info. C_] B-1 Cholinesterase Testing <br /> ----------------- <br /> ------------------------------ - <br /> PERMIT CONDITIONS ATTACHED <br /> -------------------------------------------------------------------------------- <br /> [X] P - General <br /> [X] Q - Dicamba & Phenoxy Herbicides - Central Valley/Hazardous Area <br /> [_] R - Dicamba & Phenoxys - Special Hazardous Area <br /> C-] S - Metam Sodium & Metam Potassium <br /> [-] T - Aldicarb (Temik) <br /> [_] U - Endosulfan (Thiodan) <br /> [_] V - Rice Pesticides Program <br /> C_] Molinate (Ordram) Worker Safety <br /> (_] Attachments 1-9 : Molinate (1 ,6) thiobencarb (2 , 6,7) , carbofuran <br /> ( 3, 6) , methylparathion (4,9) and malathion (voluntary: 5,8) <br /> CX] W - Methyl Bromide <br /> (_] Soil within greenhouses <br /> [_] Commodity <br /> (-] Soil injection <br /> [-J Tarped potting soil <br /> W Single tree site <br /> C_] X - FuradarA chemigation of grapes <br /> -(X]-Z---Other ✓R ote'1 +4 L� (t -------------- _----- <br /> --------------------------- <br /> ------------ - --------- --------- -------- <br /> ---- ----- <br /> -------------- - - <br /> ------------- --------------------------------------------------- <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> -------------------------------------------------------------------------- <br /> C �e 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 [_] Simazine C_l Bromacil <br /> (_] Diuron [_] Prometon [_] Bentazon <br /> 1 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 no commissioner. <br /> -------------- <br /> Purchaser Date <br />