Laserfiche WebLink
SWE OF CALIFORNIA <br /> DEPARTMENT OF PESTICIDE REGULAT ON <br /> PRIVATE APPLICATOR PESTICIDE ENFORCEMENT BRANCr <br /> CERTIFICATION STATEMENT <br /> PR-ENF-172(EST.7/91) <br /> CERTIFICATION EXPIRATION DATE <br /> PRIVrAPPLICAT1O1R NAME T APPLICATOR PHONE NUMBER <br /> ADDRESS <br /> ) a <br /> CERTIFYINS47)G COUNTY NAME PERMIT NUMBER ISSUED COUNTY PHONE NUMBER <br /> cA L/ 1 0 <br /> CERTIFICATION/PERMIT ISSUE P: / TITLE <br /> CERTIFICATION ISSUED: <br /> J�ENERAL EXAMINATION WORKER SAFETY EXAMINATION <br /> PESTICIDE SAFETY SERIES INFORMATION PROVIDED: PESTICIDE SAFETY SERIES INFORMATION ISERIES NUMBER(S)PROVIDED]: <br /> D YES 1:1 NO <br /> l certify the above information is correct and that l have taken the Private Applicator Certification examination for the possession <br /> and/or use of restricted use pesticides. i have reviewed and understand questions answered incorrectly with the issuing county. <br /> CERTIFIED IV APPL TOR S TURF. DATE SIGNED/CERTIFIEO <br /> Distribution: Original—C61nty Canary—Certified Private Applicator Pink —Copy <br /> STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATION <br /> PRIVATE APPLICATOR PESTICIDE ENFORCEMENT BRANCH <br /> CERTIFICATION STATEMENT <br /> PR-ENF-172(EST.7/91) <br /> CERTIFICATION EXPIRATION DATE <br /> Aw 13 T� <br /> PRIVATE APPLICATOR NAME APPLICATOR PHONE NUMBER <br /> ADDRESS r <br /> CERTIFYING COUhTY�j: PERMIT NUMBER ISSUED / ` COUNTY PHONE NUMBER <br /> j 4/ <br /> CERTIFICATION/PERMIT ISSUED BY: TITLE �C, <br /> CERTIFICATION ISSUED: <br /> GENERAL EXAMINATION �bRKER SAFETY EXAMINATION <br /> PESTICIDE SAFETY SERIES INFORMATION PROVIDED: PESTICIDE SAFETY SERIES INFORMATION[SERIES NUMBER(S)PROVIOEDI: <br /> D YES ❑ NO <br /> I certify the above information is correct and that/have taken the Private Applicator Certification examination for the possession <br /> and/or use of restricted use pesticides. /have reviewed and understand questions answered incorrectly with the issuing county. <br /> CERTIFI ATE APPLICAT rIARE _7 ? DATE SIGNED/CERTIFIED <br /> .� �/ '� /�. <br /> Distribution: Original—Counry ^^T;� Canary—Certified Private Applicator Pink —Cooy <br />