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DEPARTMENT OF PESTICIDE REGULATION <br /> STATE OF CALIFORNIA PESTICIDE ENFORCEMENT BRANCH <br /> MONTHLY SUMMARY PESTICIDE USE REPORT <br /> PR-ENF-060(REV.4/92) <br /> INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW AND ON THE REVERSE SIDE <br /> OPERATOR(FIRM NAMEti_ ADDRESS �} �• CITY / ZIP CODE PHONE NUMBER CJ C <br /> OPERATOR IDENTIFICATION/PERMIT NUMBER LICENSE NUMBER COUNTY(WHERE APPLIED) COUNTY NUMBER MONTH/YEAR OF USE TOTAL NUMBER OF APPLICATIONS <br /> i <br /> J �— <br /> t. Complete Columns A,B,C,and D for All Users <br /> T. 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,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 commi«ioner. <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 Fend G,If Use Does not FIt one of the Above Codes <br /> A g 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 INCLUDE ALPHA CODE (Ckde One Unk of Measure) A LICATIONS TREATED TREATED <br /> / LB OZ <br /> 4� LB OZ PT OT G <br /> LB OZ PT OT V <br /> LB HOZ PT Of GA <br /> — / v s <br /> PC) GLl �5� — y Q� LB OZ PTra - GA ,a . <br /> LB OZ PT OT GA <br /> LB OZ PT OT GA <br /> LB OZ PT OT GA ., i xp <br /> LB OZ PT OT GA i <br /> LB OZ PT OT GA jL Er ). OF A('R, -- <br /> DATE <br /> REPORT PREPARED BY l / <br /> i <br />