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Web `!R www --c- san—cauuin ca F-M ,- Office fj9 ) 468--00 Recorder iN ------------------------------------------------------------------------------- PEE, 7RICTED 14AT"-PPIALS PERMIT PERMIT 39-02-3902 County HO District I MiZU140 FARMS Expiration Date . /2 3 r a 290110 AFERN RD Effective Date TRACY, CA 95304- CLAPJ< MIZUNO Home : OFF 835-5154 29050 AHERN RD Shop : 2098355154 TRACY, CA 95304- Fax: Mobile : ( 209 ) 483-2500 Permittee Type , Permit Type Possession 1,10I Method of Submission -------------- ------------ -------------- -------------------------- Private App 1XI Seasonal 1XI Poss & Use 1XI Phone 1XI Fax lyl Q A Cert I I Job I I Poss Only I I Boy, I I Modem I I Ag PCO In Person 1X Web I I Non-Ag NOI required 24 hours prior to application Non-Ag Use: None Conditions: PgZ ------------------------------------------------------------------------------- I understand that this permit does not relieve me from liability for any damage to persons or property caused by the use of these pesticides. I waive any claim of liability for damages against the County Department of Agriculture based on the issuance of this permit . I further understand that this permit may be revoked when pesticides are used in conflict with the manufacturer 's labeling or in violation of applicable laws, regulations and specific . conditions of this permit . I authorize inspection at all reasonable times and whenever an emergency exists, by the Department of Pesticide Regulation or the County Department of Agriculture of all areas treated or to be treated. storage facilities for pesticides or emptied containers and equipment used or to be used in the treatment . [Form PR-ENF-125 (Rev. 07Z921 Pesticide Enforcement Branch] Permit A p p I i c a n t Sign : Title : Issue Date f Issuing Officer : Issue Date : Page 1