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X <br /> LSAN JOAQUIN COUNT7Z a-po3 <br /> 1868 E . HAZELTON AVENUE <br /> STOOr,TON, CA 95205 <br /> Web 'jTL : www . co. san-j oaqui n . ca . us:agcomm <br /> E-mail . <br /> Office : ( 209 ) 468-3300 Recorder 1NOI ) : f209 ) 468-3300 FA_X: ( 209 ) 468-3330 <br /> -----------------------------------------------------------------------=------ <br /> RESTRICTED MATERIALS PERMIT PERMIT fJ : 39-03-3902116 <br /> County HQ District tt : S <br /> LTHOMSEN FARMS Expiration Date : 12Z31I120 <br /> 2365 W DURHAM FERRY RD Effective Date y , <br /> IR.AC` ' CA 95376- <br /> f,'ENNETH T"HOMSEN Home : ( 209 ) 835-3136 <br /> L 2365 W DURHAM FERRY RD Shop : ( 209 ) 835-5442 <br /> TRACY . CA 95376- Fax: ( 209 ) 835-5488 <br /> Mobile : ( 209 ) 918-0651 <br /> Permittee Type Permit Type Possession NOI Method of Submission <br /> ------------- --- ------ <br /> Private App IXI Seasonal IXI Pose & Use IXI Phone JX Fax X <br /> Q A Cert I I Sob I I Pose Only I I Box I I I <br /> Ag FCO I I In Person I IXI I wet, I I <br /> iXl <br /> Non-Ag I I NOI required 24 hours prior to applicatic <br /> LNon-Ag Use : None <br /> Conditions : PQ, PA-3997717 EXP . 12-31-2005 <br /> LI understand that this permit does not relieve me from liability for any damage <br /> to persons or property caused by the use of these pesticides ; I waive any <br /> claim of liability for damages against the County Department of Agriculture <br /> based on the issuance of this permit . I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacturer ' s <br /> labeling or in violation of applicable laws, regulations and specific <br /> conditions of this permit . I authorize inspection at all reasonable times and <br /> Lwhenever an emergency exists, by the Department of Pesticide Regulation or the <br /> County Department of Agriculture of all areas treated or to be treated , storage <br /> facilities for pesticides or emptied containers and equipment used or to be use <br /> in the treatment . [Form PR-EN/F-125/. (Rev . 07/92 ) Pesticide (fEnforcement Branch] <br /> Permit ' Applicant : 1�3 &Pj &A Jpm S2, A Sign : /��- Z"094 <br /> Title : Jar{ SJ �J y * Issue Date : J' 2-4y <br /> Issuing Officer : ' <br /> Issue Date : Z-9�__ <br /> Page 1 <br />