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SAN JUAWUiN COUNTY <br /> 1868 E. HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Office : ( 209 )468-3300 Recorder (NOI ) : ( 209 )466-3300 FAX: ( 209 )468-33: <br /> RESTRICTED MATERIALS PERMIT PERMIT/OPERATOR I .D. # : 39-98-39010 <br /> County HQ District # : B <br /> COSTA INC . , DAN Expiration Date : 12/31/1998 <br /> 1269 SPRING CREEK DR. Issue Date : 5 . 2 -78 <br /> RIPON, CA 95366- <br /> DAN COSTA R Home : ( 209 ) 599-356 <br /> 1269 SPRING CREEK DR. Shop: ( 209 ) 599-212 <br /> RIPON, CA 95366- Mobile : ( 209 ) 531-612 <br /> ----------------- - --------- <br /> FOR RESTRICTED MATERIALS PERMIT USE ONLY <br /> Permit Tyne : 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 D <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 /> 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 /> 99999 NON-PERMIT AG P Weeds All Reg Ground PCO Grower <br /> Non-Ag Use: <br /> Conditions : PQ <br /> ------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------ <br /> I understand that this permit does not relieve me from liability for any damag <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 reasonable 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, storag <br /> facilities for pesticides or emptied containers and equipment used or to be <br /> used in the treatment . [Form 33-125/v3 . 53 (Rev. 02/16/90 ) Pesticide Enforcemen <br /> Branch] <br /> Permit Applicant: Sig <br /> Title : D Date : <br /> Issuing Officer: Date : /z/��/ <br />