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TATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATION <br /> ,MONTHLY SUMMARY PESTICIDE USE REPORT PESTICIDE ENFORCEMENT BRANCH <br /> PR-ENF-060(REV.4/92) <br /> INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW AND ON THE REVERSE SIDE <br /> OPERATOR(FIRM NAME) ,� ADDRESS CITY ZIP CODE PHONE NUMBER <br /> c�/1.✓ z� T l '�. �c5 - CS S %T i4f' 71K <br /> OPERATOR IDENTIFICATIONIPERMIT NUMBER LICENSE NUMBER COUNTY(WHERE APPLIED) COUNTY NUMBER MONTH/YEAR OF USE TOTAL NUMBER OF APPLICATIONS <br /> ~' — — - �lS� X4. 7 d�l � �SrI �-cr✓��.vc Z) �T o /G <br /> t. Complete Columns A,B,C,and D for All Users <br /> 2. Complete Column E by Using One of the Following Codes <br /> Code 10 - Structural Pest Control..................................includes any pest control work performed within or on buildings and other structures. <br /> Code 30 - Landscape Maintenance Pest Control.......... ncludes any pest control work performed on landscape plantings around residences,or other buildings,golf courses,parks,cemetaries,etc. <br /> Code 40 - Right-of-Way Pest Control............................ includes any pest control work performed along roadsides,power lines,median strips,ditch banks and similar sites. <br /> Code 50 - Public Health Pest Control............................ includes any pest control work performed by or under contract with State or local public health or vector control agencies. <br /> Code 80 - Vertebrate Pest Control................................ includes any vertebrate pest control work performed by public agencies or work under the supervision of the State or county agricultural commissi--qr. <br /> Code 91 - Commodity Fumigation(Nonfood/Nonfeed)...includes fumigation of nonfood/nonfeed commodities such as; pallets,dunnage,furniture,burlap bags,etc. <br /> Code 100- Regulatory Pest Control................................ includes any pest control work performed by public employees or contractors in the control of regulated pests. <br /> 3. Complete Columns F and G,if Use Does not Flt one of the Above Codes <br /> A B C D E F G <br /> MANUFACTURER AND EPA/CALIFORNIA REGISTRATION NUMBER FROM LABEL TOTAL PRODUCT USED NUMBER OF CODE COMMODITY OR SITE ACRES/UNITS <br /> /NAME OF PRODUCT APPLIED G✓ INCLUDE ALPHA CODE (Circle One Unh of Measure) APPLICATIONS / J�s� /TREATEE+D� TREATED <br /> � <br /> G� < O�� ! — Lr� ' O r LB OZ PT Qr /(" L/0 /VV/V'Cl <br /> c>t — LB OZ PT Qr Ga ! 1�r� /1/C711✓��'/'�� C c�1�-- <br /> /CC.T`/��t ' /ZvTi/cJ -0 7 '0Z LB OZ PT Qr A `�" <br /> 1VA' rf <br /> o 1165-6 �'Coo -&-,R LB OZ PT OT GA /0 <br /> LB OZ PT OT GA <br /> LB OZ PT QT GA y <br /> LB OZ PT OT GA <br /> MAR <br /> LB OZ PT OT GA HSV JUAQUIIV Glju; <br /> LB OZ PT OT GA <br /> LB OZ PT OT GA <br /> 1 <br /> REPORT PREPARED BY � DATE <br />