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SAN JOAQUIN COUNTY <br /> 868 E . HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Office : ( 209 )468-3300 Recorder ( NOI ) ( 209 )468-3300 FAX: ( 209 )468-3330 <br /> RESTRICTED MATERIALS PERMIT PERMIT/OPERATOR I . D. r : 39-97-3901076 <br /> County HQ District B <br /> COSTA INC . , DAN Expiration Date : 12/31/97 <br /> 1269 SPRING CREEK DR. Issue Date : 15-9- 177 <br /> RIPON , CA 95366- <br /> DAN COSTA R Home : ( 209 ) 599-3567 <br /> 1269 SPRING CREEK DR. Shop: ( 209 )599-2120 <br /> RIPON , CA 95366- Mobile : ( 209 ) 531-6135 <br /> --------------- <br /> FOR 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 required 24 hours prior to application. <br /> Method : phone ;X ; box ;X ; person ;X; modem ; X ; fax ; X <br /> Numb Pesticide Pest( s ) Form. Method( s ) Applicator( s ) <br /> ----- --------------- ------------ -------- ---------------- ----------------- <br /> 1051 SEVIN Larvae All Reg Ground PCO Grower <br /> 2000 DICAMBA Weeds Liquid Air Ground PCO Grower <br /> 2301 DI-SYSTON Aphid Liquid Air Ground PCO Grower <br /> 3141 GUTHION Mites All Reg Ground PCO Grower <br /> 3822 SLN METASYSTOX- Liquid Air Ground PCO Grower <br /> 3824 METASYSTOX-R Aphid Liquid Ground PCO Grower <br /> 3830 METHOMYL Larvae Liquid Air Ground PCO Grower <br /> 4840 ALUMINUM PHOSPH Rodents Fumigant Fumigate PCO Grower <br /> 3540 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 /> 39999 NON-PERMIT AG P Weeds All Reg Ground PCO Grower <br /> 4on-Ag Use : <br /> 'onditions : PQ <br /> understand that this permit does not relieve me from liability for any damage <br /> :o 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 /> '-)ased on the issuance of this permit. I further understand that this permit <br /> iay 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 reasonable times and <br /> 7henever 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 a ment used or to be <br /> [sed in the treatment . [Form 33-125/v3 . 53 ( Rev. 02/1 9 ) ic ' de Enfor ment <br /> ranch] <br /> � aL�1Permit Applicant: <br /> Sign:, <br /> Title : �� 1Date : �- <br /> $'I. Lj� Date : L� 1 <br /> Issuing Officer: _ ��.-- ' Date : f 7 <br />