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` - <br /> Fiestricted Materials Permit Conditions Page#: 1 of 3 <br /> The Following Conditions Apply To Permit## : 39--05-3900506 <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------- ------------------------------------------------------ <br /> [X] AI through A-9 General .Info. ; [_] B-1 Cholinesterase Testing <br /> _ _ ---------PERMIT-CONDITIONS ATTACHED --------- ------___-__ <br /> ----------------------------------------------------------------------------------- <br /> [X] P :- General <br /> F [k] Q. ; Dic.amba & Phenoxy Herbicides -- Central Valley/Hazardous Area <br /> [-] R ' - Dicamba & Phenoxys -- Special Hazardous Area <br /> C_] S Metam Sodium & Metam Potassium <br /> T - Aldicarb (Temik) <br /> F [_] U .- Endosulfan (Thiodan). <br /> C_ 7 V ` - Rice Pesticides Program <br /> [_] Molinate (Ordram) Worker Safety <br /> [_] Attachments 1-9. Molinate ('1 , 6) thiobencarb (2, 6,7 ) , carbofuran <br /> (3,6) , methylparathion (4,9) and malathion (voluntary: 5, 8 ) <br /> [};] W - methyl Bromide <br /> [_] Soil within greenhouses. ' <br /> L—] Commodity <br /> [_] Soil injection <br /> [_] Tarped potting soil <br /> [_] Single tree site <br /> [_] X - Furadan chemigation of grapes <br /> [_] Z - Other <br /> F. <br /> ===-------=_-__--------------- <br /> ___________________________ --- ____________-_-__--________________ <br /> ----------_-- -------------------- -- ---------__ -__-_- __--- <br /> ------PESTICIDE SALES: GROUNDWATER PROTECTION <br /> The <br /> -material I am purchasing will not be used in a Pesticide Management <br /> Z6ne (,as described in Section 6802, Title 3, California Code of Reg- <br /> ulations) for agricultural, outdoor institutional or outdoor industrial <br /> use, <br /> [_] The material I am purchasing will be used in a Pesticide Management Zone <br /> (as described. in Section 6802, Title 3, California. Code of Regulations) <br /> F fnr agricultural , outdoor institutional or outdoor industrial use and a <br /> copy of my restricted materials permit is attached. <br /> FMaterial purchased: [_] Atrazine [_] Simazine [ _] Bromacil <br /> C_] Diuron C_] Prometon C_] Bentazon <br /> f <br /> F 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) in any <br /> Pesticide Management Zone for agriculture, outdoor institutional or <br /> outdoor industrial uses except in accordance with a permit issued by the <br /> county agricultural commissioner or the director- in a county in which <br /> there is no commissioner_ <br /> --------- ------- <br /> PurchaserDate <br /> 1 <br />