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C, <br /> RFS-r'PI=Er- MATEPIALS PE MIT39-03-39021--4 <br /> MT'-7UN0 FARMS rat ion Data <br /> -1�105cf .%HEF.rY RD E41-Etc - 1 - Date <br /> Tp.t"ICIZ ci-k 9 5 3 0 4--- <br /> CLARI' M I Z U11 10 Home . OFF -335-5154 <br /> 905C <br /> J AliERN 1R.D Shop: 209�1355154 <br /> TRACY. CA 95304- F's X: <br /> Permittee Type Permit Type PossezEion Liol method of -Submission <br /> --------------- ------------ --------------- -------------------------- <br /> Private App IX( Seasonal JXJ Poss & Use 1XI Phone 1Y11 Fax !X1 <br /> A Cert I I job I I Pos.s Only Box I I Modem <br /> Ag PCO I I In Person !XJ Web <br /> No r,-ik g I I 1401 required 24 hours prior to app 1 i ca ti on <br /> Non-Ag Use : None <br /> Conditions : PQ, PAC3998483 12;31,%2004 <br /> PAC3998481 12X311'2004 <br /> I understand that this permit does not relieve me from liability for any darllaikj= <br /> to persons or property caused by the use of these pesticides. I waive any <br /> claim of liability for damages against the County Department of Agriculture <br /> based on the issuance of this permit . I further understand that this permit <br /> may be revoked when pesticidez- are used in conflict with the manufacturer 's <br /> labeling or in violation .--)f applicable laws, regulations and specific <br /> conditions of this permit . I authorize inspection at all reasonable times and <br /> whenever an emergency exists. by the Department of Pesticide Regulation or the <br /> County Department of AgriculturA of all areas treated or to be treated , storage <br /> facilities- for pesticides or emptied containers and equipment used or to be used <br /> in the treatment . [Form PR-ENF-125 (Rev. 07./92) Pesticide Enforcement Branch] <br /> Permit A p p 1 i c a n t Sign : <br /> Title: Issue Date: <br /> I-z-suing Officer : Issue Date: "t7t- --L- <br />