Laserfiche WebLink
~~ R'STRI.CTED MATERIALS PE%,IT cont. �� Paoe 5 <br /> . � <br /> ` C 'R` ADI , MICHAEL Permit #; 39'97-3900087 <br /> =============================================================================== <br /> -~ WORKERS SAFETY SERIES ATTACHED <br /> -------------------------------------------------------------------------------- <br /> [XI A-1 throush A-9 General Info. | [_] B-1 Cholinesterase Tastin9 <br /> PERMIT CONDITIONS ATTACHED <br /> ~~ -___________________________________--_________________________________-_____-_ <br /> [X] P - General <br /> [X] Q - Dicamba & Phenox, Herbicides - Central Valley/Hazardous Area <br /> ~~ C_3 R - Dicamba & Phenox/s - Special Hazardous Area <br /> [_l S - Metam Sodium (Vapam) - Sprinkler Irrioation APplication <br /> [_] T - Aldicarb !Temik) <br /> ,~ [_] U - Endosulfan (Thiodan ) <br /> [_] V - Rica Pesticides Prosrano <br /> [_] Molinate (Ordram) Worker Skfet, <br /> [_] Attachments 1-9: Molinate ( 1 , 6) thisbencarb (2, 6, 7) , czrbofuran <br /> ~~ (3, 6) , meth,lparathion ( 4, 91 and malathion (voluntary! 5, 8) <br /> 03 W - Methyl Bromide ' <br /> [_] Soil within sreenhoeses <br /> - [_] Commodit, <br /> [_] Soil injection <br /> [ Tarped pottins sail <br /> _ UM6 Sinsle tree site <br /> X - Furadan chem1sation nF erapes <br /> [_3 Z - Other, <br /> =============================================================================== <br /> _ <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ______________________-___-__________--_-_______-_'--____________ <br /> The material I am purchasins will not be used in a Pesticide Manas*ment <br /> Zone ( as described in Section 6802, Title 3, California Code of Res- <br /> ulations ) for asricultural , outdoor institutional or outdoor industrial <br /> _ <br /> use. <br /> [_] The material I am purchasins will be used in a Pesticide Manasement Zone <br /> ( as described in Section 6802, Title 3, California Code of Resulations ) <br /> - for asricultural , outdoor institutional or outdoor industrial use and a <br /> cop, of m, restricted materials permit is attached. <br /> _ Material Purchased: [_] Atrazine [_] Simazine [_] Bromacil <br /> [_] Diuron [_] Prometon [_] Bentazon <br /> I Certify under penalty of perjury that the foresoins statement is true, <br /> - and that I will not apply any mate"ial listed in Section 6800(a) in an, <br /> Pesticide Manasement Zone for asriculture, outdoor institutional or- <br /> outdoor <br /> routdoor industrial uses. excapt in accordance with a permit issued b, the <br /> - count, asr1cultura7 commissioner or the director in a count, in which <br /> there is no commissioner. <br /> Purchaser Date <br />