Laserfiche WebLink
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 Tom - CITY ZIP CODE -y PHONE <br /> ?NUMBER <br /> OPERATOR IDENTIFICATION/PERMIT NUMBER LICENSE NUMBER COUNTY(WHERE APPLIED) COUNTY NUMBER MONTWYEAR OF USE TOTAL NUMBER OF APPLICATIONS <br /> I. Complete Columns A,B,C,and D for All Users <br /> 2. Complete Column Eby 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,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 commissioner. <br /> Code 91 - Commodity Fumigation(Nonfood/Nonfeed)...includes fumigation of nonfoodlnonfeed 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 Fond G,N Use Does not Fit one of the Above Codes <br /> A B C D E F G <br /> MANUFACTURER AND EPAICALIFORNIA REGISTRATION NUMBER FROM LABEL TOTAL PRODUCT USED NUMBER OF CODE COMMODITY OR SITE ACRES/UNITS <br /> NAME OF PRODUCT APPLIED INCLUDE ALPHA CODE (Ckde One Unk of Measure) APPLICATIONS TREATED TREATED <br /> 2J� <br /> �C 15c? _ [�Lt —l�7 ZS / LB OZ PT or GA <br /> Po <br /> `t e,U,�C// ,� �(' LB OZ PT OT GA <br /> 116 s7 6 — 5 cx}D-LI LB OZ PT OT GA <br /> 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 /> LB OZ PT OT GA <br /> REPORT PREPARED BY ���%-=�X-G�i� L7 DATE <br />