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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 /> ZIP CODE PHONE NUMBER <br /> OPERATOR(FIyR�M�NAME ADDRESS <br /> CITY �� 7 <br /> TOTAL NUMBER OF APPLICCATIONS <br /> OPERATOR IDENTIFICATION/PERMIT NUMBER LICENSE NUMBER COUNTY(WHERE APPLIED) COUNTY NUMBER MONTMEAR OF;USEvcc, <br /> r. Complete Columns A,B,C,and D for All Users <br /> 2. Complete Column E by Using One o/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 BO - 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 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 /> Complete Columns Fond G,N Use Does not Flt one o/the Above Codes <br /> B C D E F G <br /> A <br /> MANUFACTURER AND EPA/CALIFORNIA REGISTRATION NUMBER FROM LABEL TOTAL PRODUCT USED NUMBER OF CODE COMMODITY TTREATEDD SITE ACTREA/TED NITS <br /> NAME OF PRODUCT APPLIED INCLUDE ALPHA CODE (CIrde One UnR d Measure) APP ATIONS <br /> e-w�.1.7/A <br /> hj 0^ <br /> OTGJ�J <br /> 4,1 7� <br /> zzi> <br /> LB OZ PTA <br /> LB 0Z Q Z/e) <br /> Crs 1J v /7 <br /> 5 T LB OZ PT OT /s C <br /> LB OZ PT OT <br /> LB OZ PT OT GA <br /> � <br /> �4_lf��C� tj O LTJ 1-5 c��l b B OZ PT OT OA AO �O 2 402S <br /> . �! a V <br /> t <br /> LB OZ PT OT GA q p <br /> LB OZ PT OT GA <br /> EPT, UF, AGH. .(-RAGY <br /> LB OZ PT OT GA <br /> REPORT PREPARED BY DATE r <br />