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APPLICATION - RESTRICTED MATERIALS PERMIT - SUPPLEMENT <br />LOCATION MAP <br />7. SEC TWN RNG ID <br />9. <br />10. <br />11. <br />12. <br />13. LW'f <br />14. <br />A <br />15. <br />16. ((v V I <br />17. iY-r �—� I✓ <br />18. Zq <br />19. <br />20. <br />21. <br />22. <br />23. <br />24. <br />16. <br />27. <br />28. <br />29. <br />30. <br />31. <br />'Formulation: L—Liquid B—Bait D—Dust F—Fumigant G—Granules <br />WP—Wettable Powder O—Other <br />"Method: A—Air F—Fumigation Gr—Ground O—Other <br />DISTRIBUTION: COUNTY AGRICULTURAL COMMISSIONER: PERMITTEE <br />COMMODITY UNITS PESTICIDES <br />APPLICANT SIGNATUR <br />ISSUED B' <br />PESTS <br />PERMIT NO. <br />PAGE NO. <br />F' M" RATE DILUTION/I DATE/ <br />VOLUME APPQ TIMING <br />STATE OF CALIFORNIA <br />DEPARTMENT OF PESTICIDE REGULATION <br />PR -ENP -125A (REV. 10/07) Page 1 O(1 <br />Prinf Form � <br />