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- <br /> SAN JOAQUIN COUNTY AGRICULTURAL COMMISSIONERS OFFICE 2012 <br /> ): 1'••.O <br /> 2101 E EARHART AVE, SUITE 100 <br /> STOCKTON, CA 95206 <br /> ::LAB Office: (209) 953-6000 Fax: (209) 953-6022 <br /> www.co.san- <br /> " TFORN P . Email: stocktonag2@sjgov.org Web: <br /> joaquin.ca.us/agcomm <br /> RESTRICTED MATERIALS PERMIT: 39-12-3904556 <br /> — Operator: VAN EXEL FARMS #3904556-2012-Version: 1 <br /> 19919 VAN EXEL RD County District#: G <br /> LODI, CA 95242- Issued on: ►/��j a <br /> Valid as of: V3/fa- <br /> Attention: KOOGER,CORNELIS P Expires on: 12/31/2012 <br /> Home Phone: <br /> Office Phone: <br /> Mobile Phone: <br /> Type of Use: Agricultural Use ORIGINAL Fax: <br /> Pesticide Notices Of Intent required 24 hours <br /> Possession: prior to application of pesticide <br /> containing restricted materials <br /> Permit Duration: Seasonal <br /> Employees Handle Pesticides <br /> Conditions: A, GWP-R2, GWP-R5, P, Q, 0 See condition detail <br /> for code descriptions. <br /> �- Regulatory Notes: <br /> --------------------------------------------------------------------------------------------------------------------------------------- <br /> understand that this permit does not relieve me from liability for any damages to any persons or property caused by the <br /> use of these pesticides. I waive any claims of liability for damages against the County Department of Agriculture based <br /> on the issuance of this permit. I further understand that this permit may be revoked when pesticides are used in conflict <br /> with the manufacturer's labeling or in violation of applicable laws, regulations, and specific conditions of this permit. I <br /> authorize inspection at all reasonable times and whenever an emergency exists by the Department of Pesticide <br /> Regulation or the County Department of Agriculture of all areas treated or to be treated, storage facilities for pesticides or <br /> emptied containers and equipment used or to be used in the treatment. I have considered alternative and mitigation <br /> measures pursuant to Title 3, California Code of Regulations, section 6426. Taking into account economic, <br /> environmental, social, and technological factors, I have adopted those that are feasible and would substantially lessen <br /> any significant adverse impact on the environment. <br /> [Form PR-ENF-125(Rev 11/06)Pesticide Enforcement Branch] <br /> Applicant: eel rn�-G,S vv e - / a✓c rnu> <br /> (Name&Title) <br /> Applicant Signature, C Date: / 3 <br /> Issuing Officer: k p Date: <br /> r <br /> Pagel <br />