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STATd OF CALIFORNIA DEPARTMENT OF PES71CIDa REG;__A".Cr. <br /> PRIVATE APPLICATOR PESTICIDE ENFORCEMENTB;ANC,, <br /> CERTIFICATION STATEMENT <br /> PR-ENP-172(EST.7/91) ICATION EXPIRATION DATE <br /> CERTIF <br /> iZ-31 -'95 <br /> PRIVATE APPLICATOR NAME APPLICATOR PHONE NUMBER <br /> ADDRESS <br /> CES IN G COUNTY NAM � �.. ` PERMIT NUMBER ISSUED COUNTY PHONE N UMB�RO , <br /> 3� -95-39 0 l 07� <br /> CERTIFICATION/PE MIT ISSUED BY: TITLE <br /> ' i S - - 05. <br /> CERTIFICATION ISSUED: <br /> GENERAL EXAMI ATION WORKER SAFETY EXAMINATION <br /> PESTICIDE SAFETY SERIES INFORMATION PROVIDED: PESTICIDE SAFETY SERIES INFORMATION[SERIES NUMBER(S)PROVIDED): <br /> YES NO See rn^,-t- <br /> 1 certify the above information is correct and that I have taken the Private Applicator Certification examination for the possession <br /> and/or use of restricted use pesticides. I have reviewed and understand questions answered incorrectly with the issuing county. <br /> CE FIFA TE APPLICATOR SldNAATURE DATE SIGNED/CERTIFIED <br /> Dlsvlbutlon: Original—County Canary—Certified Private Applicator PtnK —COD, <br /> r,. <br />