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-ESTPMATERIALS PERMIT continued ..... Page t: 3 <br /> -FAN DE FOL, JOHN ..- ..eermit#: 39-01-3903339 <br /> ----------------- - <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------ <br /> '"[X] A-1 through A-9 General Info. C_) B-1 Cholinesterase Testing <br /> - -- - -- -- -- -- <br /> --- -- - ---------- ------- <br /> ------------------------------------------------------------------ <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> [i P - General <br /> [X1 0 - Dicamba & Phenoxy herbicides - Central Valley/Hazardous Area <br /> [_] R - Dican?ba & Phenoxys - Special Hazardous Area <br /> [_) S - Metam Sodium (Vapam) <br /> [_) T - Aldicarb (Temik) <br /> [_] U - Endosulfan (Thiodan) <br /> [_) V - Rice Pesticides Pr�ogra, <br /> [_I Molinate (Ordram) Worker Safety <br /> [_1 Attachment_ 1-9: Molinate (1,6) thiobencarb (2,6,7), c.a13_. }fszrat� <br /> (3,6), methylparathion (4,9) and malathion (voluntary. 5,81 <br /> [Xi ,a3 - �'feth y l Bromide <br /> [_1 Soil within green1houses <br /> ti<<iil iT]jectiOT; <br /> [-j Tarped potting soil <br /> tree site <br /> [_) X - Furadan chemigation of grapes <br /> [XJ 1 - Other <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ---------------------------------------------------------------------------------- <br /> The n!ater i a l I am purchasing' will not be used in a Pesticide Managemient <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 /> C_1 The material I am purchasing vdill be used in a Pesticide Management Zl-?ne <br /> (as described in Section 6802, Title 3, California Code of Regulations) <br /> for agricultural, outdoor institutional or outdoor industrial use :and a <br /> cony of restricted materials Permit is attached. <br /> Yfaterie.l purchased: [_1 Atrazine [_] Simazine F-1 Bro,nacil <br /> [_) Piuron C_1 Prometon [_1 '- 1ht <br /> I 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) ill al:iy <br /> Pesticide Management Zone .for agriculture, outdoor institutional or <br /> outdoor industrial uses except in accordance with a permit issued by the <br /> counVy ?Rricultural co1Tl-Ass ones or the director in a county hi whicth <br /> th.er, i-:, no co zrIS for .r_ <br /> Purchaser <br />