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F <br /> Y <br /> 1868 E. FLAZELTO NN X'tTINUIE <br /> E STS�CTK i()N, CA 95205- <br /> ' F—rnai;'. � +e€:t:utfi.e s.sar•;c«qum.ca.us a cenuzi <br /> Office: (209)4680-33401 Fax: (209)468.3330 Pecorder(NOI'a)`. (i0914oa•3"a3C <br /> RESTRICTED BUTERIALS' PERMIT <br /> ► Pennrt Number: 39-1 -39CA2 s4 <br /> Fill K OYMAN J.,aOFN <br /> 5525 W TURNER RD <br /> 1iOu ty G <br /> LODL CA 95242- Expkation Date: Decernber a 1, 200 i <br /> Effectiw- Date. , V <br /> Al-/Z <br /> ' fTbO ''iAN Horne Phone: (209)368-2814 <br /> °�I <br /> 5525 W TURNER RD Shop Phone: <br /> > Mob a Phone: <br /> i } Fax: <br /> Pertr*tee Type- Private Applicator NDI Method of Subafissio-n: <br /> Pewit Type- Seasonal Phone: X Fay. X Box: <br /> Possession: Possession&Use laPerson: X Modem: X Web: <br /> NUT required 24 hours prior"to awlicatiorr. <br /> 1 Conditions: AX See end of permit for <br /> code descriptions. <br /> I understand that this permit does not relieve me frofn liability for any darxzages to any persons or property caused <br /> by the use of these pesticides. I wive any claims of liability for damages against the County Department of <br /> Agriculture based on the issuance of this permit. I further understand that this permit may be revoked when <br /> pesticides are used in conflict with the manufacturer's labeling or in violation of applicable lass,regulations and <br /> specific conditions of this permit. I authorize inspection at all reasonable times and whenever an emergency exists <br /> by the Department of Pesticide Regulation or the County Department of AgriculLure of all areas treated or to be <br /> treated,storage facilities for pesticides or emptied containers and equipment used or to be used in the treatnierL <br /> [Fon-ii PR-E1'TF-125 (Rev. 07 f92:)Pesticide Enforcement l ra.`a,] <br /> P Permit Appltcairt: v� l� J O b �/!f�1 i )V V ° Signe ', <br /> Please Print) <br /> Issue Date. <br /> l �r. <br /> F i <br /> Ik` t (Please Pc'E) <br /> Issuing Officer: �-- Tssue Date. <br /> i Lr <br /> a <br />