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RESTRICTED NATERIALS PERM T + cont. Page - <br /> - SChr1l_LBERGEi, ,TiDi-;i•; :-ermi't #: 39-99-390462_3 <br /> WORKERS SAFETY SERIES ATTACHED <br /> ------------------------------------------------------------------------------- <br /> CX] A--1 through A--9 General Info. [_] B--1 Cholinesterase Testing <br /> PERMIT CONDITIONS ATTACHED <br /> ------------------------------------------------------------------------------- <br /> _. CX] P - General <br /> j XI 0 - Dicamba =. Phenoxy Herbicides - Central Val ley/Hazard Ous Area <br /> E-3 <br /> r e a- <br /> C_, R - Dicamba. & Phenoxys •- Special Hazardous Area <br /> _ C_] S - Metam Sodium (Vapam) <br /> C-1 T -- Aldicacb (Temik ) <br /> C_] 'J - Endosulfan (Thiodan ) <br /> C-1 V - dice Pesticides Program <br /> - 1 Mo y,ri_tte (Grdram) Worker Safer. <br /> [_] Attachments 1-9: Molint.te ( 1 ,6) thioben+=._+.rb (2,6,7) q carboiura(- <br /> (_,6) , methylpar athion 14,9) .and malathion (voluntary; 5 , S) <br /> _ C_] W -- Methyl Bromide <br /> C_? Soil within greenhouses <br /> C_] Commodity <br /> C_] Soil injection <br /> C_] Tarped potting soil <br /> E_1 Single tree site <br /> C_J X - Furadan r-hem.igation of grapes <br /> C_1 Z - Other <br /> PESTICIDE SALES: GROUNDWATER PROTECTION <br /> ------------------------------------------------------------•-------------��----- <br /> _Pjj The material I am purchasing will not be used in a Pesticide Management <br /> Zone (as described in Section 6302, Title 0, California Code of Reg- <br /> ulations) for agricultural , outdoor institutional or outdoor industrial <br /> use. <br /> C_; 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 /> for agricultural , outdoor institutional or outdoor- industrial use and a <br /> copy of my restricted materials permit is attached. <br /> {aterial. purchased : C__] atrazine C_3 Simacine C _ ! Br-omac it <br /> C_1 DiiIron C " Prometcn C_1 Stentazon <br /> I Certify under- penalty of perjury that the foregoing statement is true, <br /> and that I will not apply any material listed .in Section 6300(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 `r_ommissioner. <br /> Q_�_AJ____;2-------- - 1 -27- ---- <br /> Furchaser Date <br />