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SAN JOA j- <br /> COUNT'-1 <br /> N % <br /> 868 E. IIAZELTON AVENUE �( <br /> STOCI�TON, CA 95205 <br /> office: ( 209 )468-01300 Recorder (NOI ) : ( 209 )468-000000 FAA: ( 209 )468-3330 <br /> ;vLSTRICTED MATERIALS PERMIT PERMIT/OPERATOR I .D. # : 39-98-3903339 <br /> County IIQ District #: C <br /> VAN DE FCL, JOIIN Expiration Date: 12/31/1998 <br /> 18251 STEINEGUL Issue Date: 06/22/1998 <br /> —E-SCALON, CA 95320- <br /> JOHN VAN DE FOL Home: ( 209 )8318-1480 093 <br /> )88-1480 <br /> ,..18251 S T E I NE GU L Shop: ( 20911838-1480 <br /> ESCALOI1. <br /> N CA 95320- Mobile : <br /> FOR RESTRICTED RiATERIALS PER MI T USE C11LY <br /> "'Permit Type: Foss . r c ry r,_ vl r l <br /> Only 13easonal ria] rvSS . & Use [nJ Job r <br /> Permittee Type: Q.A. Cert [ ] Ag. FCO [ ] Private App [X] Non-Ag [ ] <br /> NOI required 24 hours prior to application. <br /> -4/tethod: Phone [X] Box [X] Person [X] Modem [ ] Fax [X] <br /> ------------------------ <br /> Numb Pesticide Pest( s ) Form. Method( s) Applicator(s) <br /> ----- --------------- ------------ -------- ---------------- ----------------- <br /> 1051 SEVIN Larvae Liquid Air Ground FCO Grower <br /> 1360 CIILOROPICRIN Nematode Fumigant Fumigate FCC Grower <br /> 3850 METIIi'L BROMIDE Soil/Stored Fumigant Fumigate FCO Grower <br /> `'4840 ALUMINUM PIIOSFII Rodents Fumigant Fumigate FCO Grower <br /> 5540 STRYCIININE Gophers Bait Ground FCO Grower <br /> 7860 MCPA, DIMETHYLA Weeds Liquid Air Ground PCO Grower <br /> x.9801 2 ,4-D AMINE Weeds Liquid Air Ground FCO Grower <br /> 16011 PARAQUAT `deeds Liquid Ground FCC Grower <br /> Non-Ag Use: <br /> onditions : PQti7 <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 revoked 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 <br /> used in the treatment . [Form 33-125/v01 . 53 (Rev. 02/16/90 ) Pe icide Enforcement <br /> BranchOa�A <br /> i <br /> Permit Applicant: ,)r)Y h fia �, Sign: <br /> Title : V Lj V1 e- V- Dat 14r,I 74L <br /> 2 2 � <br /> Issuing Officer . ��'-% _ Date: <br />