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SAN JOAQUIN COUNTY <br /> 1868 6 o E. HAZELTON AVENUE ti/ <br /> STOCiiTON, CA 952105 <br /> Office : (209 )468-3300 Recorder (NOI ) : (209)4608-3300 FAX: ( 209 )460-3330 <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> `RESTRICTED MATERIALS PERMIT Permit#: 39-00-3903339 <br /> County HQ District# : C <br /> —VAN -DE POL, JOHN Expiration Date: 12/31/2000 <br /> 18251 STEINEGUL Effective Date <br /> ESCALON, CA 95320- —�q��a <br /> JOHN VAN DE POL Honie: ( 209 )0838-1480, <br /> 18251 STEI13EGUL Shop: ( 2009 )8308-14800 <br /> ESCAL013, CA 95320- Fax: <br /> — 1 1 <br /> L`1U U11e <br /> Permittee Type Permit Type Possession NOI Method of Submission <br /> -------------- ------------ -------------- -------------------------- <br /> Private App [X] Seasonal [X] Puss & Use [X] Phone [X] Fax [X] <br /> Q A Cert [ ] Job [ ] Puss Only [ ] Box [X) riodem [ ] <br /> Ag PCO [ ] In Person [X], <br /> Non-Ag [ ] NOI required 24 hours prior to applicatioi: <br /> ------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> ivumb Pesticide Pest(s ) Form. Method(s ) App'Licator( s) <br /> ----- --------------- ------------ -------- ---------------- ----------------- <br /> 1.051 SEVIN LARVAE Liquid Air Ground PCO Grower <br /> 1300 CHLOROPICRIN NEMATODE Fumigant Fumigate PCO Grower <br /> 2000 DiCAriBA WEEDS Liquid Air Ground PCO Grower <br /> 3030 METHOMIL LARVAE Liquid Air Ground PCO Grower <br /> 3050 METHYL BROMIDE SOIL/STORED Fumigant Fumigate PCO Grower <br /> 4840 ALUMINUM PHOSPH RODENTS rums 1 <br /> galit Fumigate PCO �tGr <br /> vweY- <br /> ` 5540 STRYCHNINE GOPHERS Bait Ground FCO Grower <br /> 7860 MCPA, DIMETHYLA WEEDS Liquid Air Ground PCO Grower <br /> 9001 2 , 4-D AMINE WEEDS Liquid Air Ground PCO Grower <br /> - 1601.1 PARAQUAT WEEDS Liquid Ground PCO Grower <br /> ****** PESTICIDES CONTINUED ON NEXT PAGE * **** <br /> Non-Ag Use : <br /> ` Conditions : PQW (;ZkL At321go exp, 12^31�0� <br /> I understand that this permit does not relieve me from liability for arty 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. t'flis permit . I further understand that this permit <br /> i.- may be revoked when pesticides are used in confi.ict with the manufacturer' s <br /> labe'Ling 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 /> foci'Litles for pesticides or emptied containers and equipo n'" sed . U use( <br /> tri the treatment . [For PR-E'Vr-125 PY <br /> . 01./92 ) Pesticide E 'c Pit Br n ] <br /> — <br /> Permit Applicant : O Sign: /d <br /> r.. Title : 111W,12 fir- Date : -I <br /> Issuing Officer : �/ �GL�� Date : I f / r 0 o <br /> r <br />