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SAN JOAQUIN COUNTY <br /> 1868 E . HAZELTON AVE . ✓ <br /> STOCKTON, CA 95205 <br /> Offices : ( 209 )468-3300 Recorder ( NOI ) ( 209 )468-3330 FAX: <br /> RESTRICTED MATERIALS PERMIT PERMIT/OPERATOR I . D. T : 39-94-3901076 <br /> County HQ District B <br /> COSTA INC. , DAN Expiration Date : 12/31/94 <br /> 1269 SPRING CREEK DR. Issue Date : 02/28/94 <br /> RIPON, CA 95366- <br /> DAN COSTA R Home : ( 209 ) 599-356_7 <br /> 1269 SPRING CREEK DR. Shop: (z-q )Srfi - Z1 c <br /> RIPON, CA 95366- Mobile : (2017- <br /> FOR <br /> z:1FOR RESTRICTED MATERIALS PERMIT USE ONLY <br /> Permit Type : Poss . Only ; Seasonal ;X; Poss . & Use ; X ; Job <br /> Permittee Type : Q.A. Cert ; Ag. PCO ; Private App ; X ; Non-Ag <br /> NOI repquired 24 hours prior to appliation. <br /> Method : phone ;X ; box ;X ; person ;X; modem ; X ; fax ;X <br /> Numb Pesticide Pest( s ) Form. Method( s ) Applicator( s ) <br /> ----- --------------- ------------ -------- ---------------- ----------------- <br /> 3822 SLN METASYSTOX- Liquid Air Ground PCO Grower <br /> 3830 METHOMYL Larvae Liquid Air Ground PCO Grower <br /> 4840 ALUMINUM PHOSPH Rodents Fumigant Fumigate PCO Grower <br /> 5540 STRYCHNINE Gophers Bait Other PCO Grower <br /> 7860 MCPA, DIMETHYLA Weeds Liquid Air Ground PCO Grower <br /> 9801 2 , 4-D AMINE Weeds Liquid Air Ground PCO Grower <br /> 16011 PARAQUAT Weeds Liquid Air Ground PCO Grower <br /> 20080 PERMETHRIN Larvae Wettable Air Ground PCO Grower <br /> 22941 ASANA Larvae Liquid Air Ground PCO Grower <br /> Non-Ag Use : <br /> Conditions : PQ <br /> ---------------------------- <br /> I understand that this permit does not relieve me from liability for any 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 /> based on the issuance of this permit . I further understand that this permit <br /> may be revoked when pesticides are used in conflict with the manufacturer' s <br /> labeling or in violation of applicable laws , regulations and specific <br /> conditions of this permit. I authorize inspection at all rwasonable times and <br /> whenever an emergency exists, by the Department of Pesticide Regulation or the <br /> County 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 <br /> used in the treatment . [Form 33-125/v3 . 53 (Rev. 02/16/ Pesticide E orcement <br /> Branch] <br /> Permit Applicant : Sign: C <br /> Title : aefog ..^ Date : 2 2 <br /> Issuing Officer: �. Date: �� <br />