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Restricted Materials Permit Conditions Page#: 1 of 3 <br /> The Following Conditions Apply To . . . . . . . . . . . . . . . . . . . . . . Permit# : 39-03-3900140 <br /> WORKERS SAFETY SERIES ATTACHED <br /> ` LX] A-1 through A-9 General Info. [_] 3--1 Cholinesterase Testing <br /> ------------- <br /> L PERMIT CONDITIONS ATTACHED <br /> ` 'X] Q - Dicamba & Phenoxy Herbicides Central Valley,'Hazardous Area <br /> R Dicamba & PhFwnoyys - Special Hazardous Area <br /> L_] S Metam Sodium & Metam Potassium <br /> L_] T - Aldicarb (Temik) <br /> L_] TJ - Endosulfan (Thiodan) <br /> L_] V Rice Pesticides Program <br /> [_] Moli.nate (Ordram) Worker Safety <br /> L [_] Attachments !- 9 ; Molinate ( 1 , 6) t•1:'�C+1?L'IiC' <br /> (3, 6) , metl;ylparlat1.'iol7 (4 ,9 , a.,)(i t,,,,1r.+.,hi,�T; (voluntary: <br /> [X] W - Methyl. Brom? A.- <br /> [_ :1 1 I within greenhouses <br /> I_] Commodity <br /> [_] Soil injection <br /> L_] Tarped potting soil <br /> [_] Single tree site <br /> [_] X Furadan chemigation of grapes <br /> [_] Z Other <br /> L <br /> G'RC',UNDWATER PROTECTION <br /> L_] T:le MatErial I am purchasing will not-be used in -aFeoticide Management <br /> LZone (as described in. Section 0802, Title 3, California Code of Reg-- <br /> ulations) for agricultural , outdoor institutional or outdoor industrial <br /> ue . <br /> L_] The material I am purchasing will be used in a Pesticide Management Zone <br /> (as described in -Section 0802, Title .7t, California Lode of Regulations; <br /> for agricultural , outdoor institutional or outdoor industrial use and a <br /> copy of my restricted materials permit is attached. <br /> Material. purchased : [_] Atrazine [_] Sima' ine [_; Sromacil <br /> [._] D`uron [_ I Prometc-n [_; Eentazon <br /> I Certify under penalty C>f peI'.;LIY'y that the Lt'oreg o-, lig :vCa:.elnent, i.:% true, <br /> and that I will not apply any tnatt,rial listed i n St ct i:sn 6f30��(a; it ,.�iiy <br /> pesticide Management Zone for agriculture , .outdoor 4nst.itutiona2. or <br /> outdoor industrial use-- e.<c:ept• in accordance with a permit issued -"y <_ <br /> county agricultural corrmiss inner or the director a <br /> there io no t ornm`ssicr:,�r. <br /> Purchaser r ^tfi <br /> L <br /> i <br />