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SAN OAQUIN NsRestricted Materials Permit— Supplement Application <br />C C U I Y �r Permit##: 39��% O� 6 "f) <br />Operator: <br />Date: 3�/Or2D� <br />i --method: A=air Name C/ <br />i F=Fumigation <br />A1C-:�7LGt(4:.(�D__i.CPr frv: IZI,C20 <br />—Signature <br />` Date <br />Page # I Of <br />DIRECTIVE <br />T <br />PCB/ <br />SITE ID <br />LOCATION <br />TWN <br />RNG <br />SEC <br />Check Box) <br />COMMODITY <br />ACRES <br />PESTICIDES <br />= <br />PESTS <br />Grower <br />:.DD <br />CH:.NGE <br />RELIOVE <br />UNITS <br />5 <br />o <br />Applied? <br />O <br />Z <br />N/Co�ltstock <br />OZP4 <br />o7E <br />I t <br />d-ee, 5e,"' J <br />2. �U <br />f <br />�PPICs <br />A/s�rv�rtn f�%iar. <br />B <br />C� <br />poa�U,f� <br />�B CT <br />3. <br />Tim P/�asP.4sd� <br />g <br />cdG,�s <br />4. <br />5. <br />tCstt <br />L <br />Cj <br />lf�G�cfs <br />6. <br />7. <br />fr ��ih <br />8 <br />�OPhuf <br />9. <br />10. <br />11. <br />1Z. <br />13. <br />14. <br />15. <br />'Formulation: <br />jL=liquid B=Bait ; Applicant: Jacob Samuel <br />3-11-2021 <br />!D --Dust F=Fumigant $ Name <br />Date <br />iG=Grcnule d <br />1WP=Wettable Powder <br />30=other Issued ByQulit�r�ID�l{1lN�� <br />i --method: A=air Name C/ <br />i F=Fumigation <br />A1C-:�7LGt(4:.(�D__i.CPr frv: IZI,C20 <br />—Signature <br />` Date <br />Page # I Of <br />