APPLICATION-RESTRICTED MATERIALS PERMIT
FOR POSSESSION ONLY
FOR POSSESSION AND USE
TYPE OF PERMIT
NOTICE OF INTENT REQUIRED A. PESTICIDES/PESTS
STRUCTURAL PCO MUST BE SUBMITTED AT LEAST
AGRICULTURAL PCO HOURS PRIOR TO APPLICATION. METHOD:
7. PCO NAME
JUSTIFICATION FOR NON-AG USE:
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 or 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 manufacture'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.
*FORMULATION: L--LIQUID B--BAIT D--DUST F--FUMIGANT G--GRANULES WP--WETTABLE POWDER O--OTHER
A--AIR GR--GROUND F--FUMIGATION O--OTHER
RESTRICTED MATERIAL PERMIT IS HEREBY GRANTED FOR THE ABOVE MATERIALS.
DISTRIBUTION: WHITE & YELLOW-COUNTY; PINK & GOLD-PERMITTEE