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SAN JOAQU I N COUNTY <br /> i B 5 8 E . HACELTON AVENUE <br /> STOCK161 I, CA 95205 <br /> `web URL E-mail <br /> office ( 209 ) 468-3300 Recorder (NOI ) ( 209 ) 468-3300 FAX ( 209 ) 468-3330 <br /> 4 a�-ESTRICTE'D MATERIALS PERMIT PERMIT 4 39-04-3904274 <br /> County HQ District # : G <br /> f ' F€ 3YM1N, 3QHN JR Expiration Data : 12✓31/2004 <br /> 5525 W TURNER RD Effective Bate <br /> LODI , CA 95242- <br /> JOAN <br /> 5242-JO N KOOYMAN Home : ( 209 ) 368-2814 <br /> 5525 W TURNER RD Shop : ( ) - <br /> } LODI , CA 95242- Mobileax: ( ) - <br /> ..� <br /> permittee Type Permit Type possession NOI Method of submission <br /> Gw -------------- ------------- -----=---------- ---------------------------- <br /> ?rivate App [XJ Seasonal 1n[ Poss L Use [XI Phone [X[ Fax Ix[ <br /> Q A Cert I [ Job Pass Only [ I Box . [X[ modem IX[ <br /> I g PCC] { In Person [X[ Web I [ <br /> Ston-Ag [ [ NOI required 24 hours prior to application <br /> V <br /> on-Ag Use : Non€ <br /> ondi t ions : P'Z- <br /> el understand that this permit does-not relieve me from liability forany 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 /> Fbased an the issuance of this permit . I further understand that this permit <br /> ay be revoked when pesticides are Used in conflict with the manufacturer '8 <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 /> Fwhenever an emergency exists , by the Department of Pesticide Regulation or the <br /> ounty 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 used <br /> n the treatment . [Farm PR-ENF-125 (Rev. 07/92 ) Pesticide E'nf rcement Branch] <br /> k Permit Applicant : <br /> Title. : U ,Q. sly Sign : <br /> ` Issue De 6 <br /> sissuing officer : � Issue Date : � - o l <br /> I Page 1 <br /> AJ <br /> f <br /> I <br /> f _ J <br />