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STATE DEPARTMENT <br /> PESTICIDE USE REPORT <br /> DEPARTMENT OF PESTICIDE REGULATION <br /> PR-ENF-025(REV.299) <br /> NURSERY <br /> COUNTY NO. BECTON TOWNSHIP RANGE BASE& APP.MEINOO PERMITTEE/PROPERTYOPERATOR APPLICATOR NAME ANDA <br /> J`A/yam ET MERIDIAN <br /> N AIHI] <br /> 1— ( 1 1p 3 S 4� W 5 OTHERO <br /> ` ra <br /> PLANTED JERRY ATKINS <br /> OPERATOR ID'PERMITNUMBER SITE IDENTIFICATION NUMBER AOCRESNNITS 12332 E. Hwy 26 <br /> Stockton, CA 95215 <br /> BLOCK ID <br /> LOCATION (IF APPLICABLE) <br /> 11 .�J- 12 13 <br /> DATEm APPLIED ACREStt1N1T EATED COMMODITY/SITE TREATED <br /> 14 15 1s <br /> CHEM MA FAC RERMAME OF PRODUCT PPLIED EPAICALIF.REGISTRATIDN NUMBER FROM LIBEL TOTAL PRODUCT USED RATE 21LUTION <br /> 17 IS <br /> /i•s 3 <br /> tn. oz P�ry. Gr <br /> Illp <br /> �O.JL <br /> YT <br /> L _ l ` LB. ozQT- <br /> U). Oz PI. OT. GA. <br /> {H. OZ. PT. OT. GA. <br /> UL OZ. PT. OT. GA. <br /> DAYS REENTRY DAYS PRENARVEST APPUEMUPEFMSED BY OSP B1 63497 <br /> 24 25 a <br /> • Submit WHITE AND PINI(COPY to theCOUNTYAGRICULTURAL COMMISSIONER within 7 days of application. <br /> Forth Distrubution: White Copy--Agricultural Commissioner,, Pink copy--DPR; Canary copy--Applicator, Goldenrod m Grower <br /> . <br />