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STATE 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 /> OPERATOR IDENTIFICATIONMERMIT NUMBER LICENSE NUMBER (WHERE APPLIED) COUNTY NUMBER MONTHIYEAR OF USE TOTAL NUMBEROFAPPLICATIONS <br /> COUNTY BE <br /> f. 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.......... includes any pest control work performed on landscape plantings around residences,or other buildings,golf courses,parks,cemeteries,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 comm;--loner. <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 /> A Complete Columns F and G,N Use Does not Flt one of the Above Codes <br /> A B C D E F t3 <br /> MANUFACTURER AND EPA/CALIFORNIA REGISTRATION NUMBER FROM LABEL TOTAL PRODUCT USED NUMBER OF CODE COMMODITY OR SITE ACRESJUNITS <br /> NAME OF PRODUCT APPLIED INCLUDE ALPHA CODE (Ckde One Unk of Measure) APPLICATIONS TREATED TREATED <br /> c�-lE�rjtiuvl,e f C -cv� <br /> LB OZ PT OT GA <br /> LB OZ P OT GA Ll ly(_/ .4/6;A!— /0 2t <br /> , �. <br /> -lGru�7�r[;C/r� A� v�►' r /6 C7" 00a y— (:i LB OZ PT OT G <br /> /QC) _ 30 - <br /> LB <br /> � <br /> 1% / b �j�'— 5 d�� � LB oz PT OT GA S V� N Z�A-,' <br /> LB OZ PT OT GA <br /> LB OZ PT OT GA <br /> LB OZ PT OT GA <br /> LB OZ PT OT GA <br /> LB OZ PT OT GA <br /> LB OZ PT OT GA <br /> REPORT PREPARED BY ��U DATE <br />