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SAN JOAQUIN COUNTY <br /> 1868 E. HAZELTON AVENUE <br /> STOCKTON, CA 95205- <br /> E-mail: vdeb:w- w,co.son-joaquin ca uslagco am <br /> Office: (209>468-3300 Fax: (209)468.3330 Recorder(NOI's): (209)46o-3300 <br /> RESTRICTED MATERIALS PERMH <br /> Permit Number: 39-05-3904641 <br /> SIA40ES DAIRY County District#: G <br /> 5630 W WOODBRIDGE RD <br /> LODI, CA 95242- Expiration Date: December 31, 2005 <br /> Effective Date: 3anuary4,-19ft <br /> 1� LL1IZ Home Phone: {209}369-2491 <br /> 5630 W WOODBRIDGE RD Shop Phone: ( } - <br /> LODI,CA 95242- Mobile Phone ( } - <br /> 17111c <br /> Permittee Type: Private Applicator NOI Mefad of Submission <br /> Permit Type: Seasonal Phone: X Fns. X Bax: <br /> Possession Possession&Use In Person: X Modem Web: X <br /> NOI required 24 hours prior to application. <br /> Conditions: A> ,Q See end of pert for <br /> code descriptions. <br /> i understand that this permit does not relieve me from liability for any damages to any persons or property caused <br /> by the use of these pesticides. I waive any claims of liability for damages against the County Deportment of <br /> Agriculture based on the issuance of this permit I further understand that this permit may be revoked when <br /> pesticides are used in conflict with the manufar_tu-ees labeling or in violation of applicable laws,regulations and <br /> specific conditions of this permit I authorize inspection at all reasonable times and whenever an emergency ecists <br /> by the Department of Pesticide Regulation or the County Deportment of Agriculture of all areas treated or to be <br /> treated,storage facilities for pesticides or emptied containers and equipment used or to be used in the treatment <br /> [Form PR-El-TF-125 (Rev. 07/92)Pesticide Enforcement Branch <br /> Permit Applicant Signed f <br /> (P ase Prmt) <br /> Tide: ; Issue Date: <br /> (K-Ase se Prnt) <br /> Issuing Officer: �Ujl;lu-0 !d Issue Date: <br />