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SAN JOAQUIN COUNTY <br /> 1868 E. HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Office: ( 209 )468-3300 Recorder (NOI ) : ( 209 )468-3300 FAX: ( 20b ,-�68-3330 <br /> .RESTRICTED MATERIALS PERMIT PERMIT/OPERATOR I .D. # : 39-99-3903339 <br /> County HQ District #: C <br /> VAN DE POL , JOHN Expiration Date: ;2.-3+-55' <br /> 18251 STEINEGUL Issue Date: <br /> �ESCALON, CA 95320- <br /> JOHN VAN DE POL Home : (209 )838-1480 <br /> -18251 STEINEGUL Shop: (209 )838-1480 <br /> ESCALON, CA 95320- Mobile: <br /> FOR RESTRICTED MATERIALS PERMIT USE ONLY <br /> Permit Type: Poss. Only [ ] Seasonal [X] Poss. & Use [X] Job [ ] <br /> Permittee Type : Q.A. Cert [ ] Ag. PCO [ ] Private App [X] Non-Ag [ ] <br /> NOI required 24 hours prior to application. <br /> Method: Phone [X] Box [X] Person [X] Modem [ ] Fax [X] <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> Numb Pesticide Pest( s ) Form. Method(s) Applicator(s) <br /> ----- --------------- ------------ -------- ---------------- ----------------- <br /> 1051 SEVIN Larvae Liquid Air Ground PCO Grower <br /> 1360 CHLOROPICRIN Nematode Fumigant Fumigate PCO Grower <br /> „-2000 DICAMBA Weeds Liquid Air Ground PCO Grower <br /> 3830 METHOMYL Larvae Liquid Air Ground PCO Grower <br /> 3850 METHYL BROMIDE Soil/Stored Fumigant Fumigate PCO Grower <br /> 4840 ALUMINUM PHOSPH Rodents Fumigant Fumigate PCO Grower <br /> a"5540 STRYCHNINE Gophers Bait Ground PCO Grower <br /> 7860 MCPA, DIMETHYLA Weeds Liquid Air Ground PCO Grower <br /> 9801 2 , 4-D AMINE Weeds Liquid Air Ground PCO Grower <br /> 16011 PARAQUAT Weeds Liquid Ground PCO Grower <br /> 16891 SUPRACIDE Larvae Liquid Air Ground PCO Grower <br /> Non-Ag Use: <br /> Conditions : PQW <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> I understand that this permit does not relieve me from liability for any damage <br /> a-c p=cnc cr prcperty auze l !�-y th—_ u!!e .,f tb+000 rootir.i rloc T rr�i.rn orcr <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/v3 .53 (Rev. 02/16/90) P icide. Enforcement <br /> Branch] <br /> Permit Applicant: �1D �Jq, l}e� l Sign: <br /> Title: C7 U.7 (E- Dateti .7 ` U -T <br /> Issuing Officer: Date: <br />