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San Joaquin County Checklist <br />YDS NO <br />L ❑ QDo you lease any of the land/sites that you will be applying pesticides to? <br />2.0 ❑ Do you have employees? If "no" then go to question 4. <br />If so, who trains them? <br />2. �] ❑ If you have employees, do they use any respiratory protection while spraying? <br />3. ❑ Q Do you have employee housing? If so, where is it located in relation to your <br />treatment areas? <br />4. ❑ EJ Do you use farm labor contractors? If so, go to question 4a. If not, go to <br />question 5. <br />4a) Who do you use? <br />5. ❑ ❑ Do you applyy pesticides aerially? If so, which pest control business do you use? <br />6. F ] [] Do you use a registered Pest Control Adviser? If so, who do you use? <br />µ 1 ®'c(NG!cc. `c•__ <br />7. ❑ 0 Do you intend to use any fumigants? If so, which ones? <br />8. ❑ D Are you within % mile of a public school and/or daycare? <br />9. ❑ ❑ If you answered YES to question 8, have you submitted your annual notification(s)? <br />100 E Do you grow organic commodities? If so, which sites? <br />11. ❑ 10 Do you have sensitive sites on or near your property (example: groundwater protection areas, <br />seasonal creeks, irrigation ditches, ponds, schools, etc.)? If so, what are they? <br />12.❑ ❑ If you are a producing faimer, are you aware of the San Joaquin County Watershed Group? <br />13.❑ El Have you set up an online CalAgPermit account (to review permit and submit <br />pesticide use reports) with us yet? <br />14 ❑ ❑ Do you intend to spray any right-of-ways around your property(s)/site(s)? <br />150 ❑ Do you have any heritage pesticides you'd like to dispose of? <br />16. What's your email address (for CAC use only): <br />ALL Notice of Intents (NOIs) shall be submitted by 4.0Opm11 iday. <br />Permittee's Name �__ Today's Date <br />