STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE … · Your Pest Company 1234 California Ave....
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03/09/2009 R E B M U N E N O H P E D O C P I Z Y T I C S S E R D D A ) E M A N M R I F ( R O T A R E P O OPERATOR IDENTIFICATION/PERMIT NUMBER LICENSE O M R E B M U N Y T N U O C ) D E I L P P A E R E H W ( Y T N U O C R E B M U N T A C I L P P A F O R E B M U N L A T O T E S U F O R A E Y / H T N IONS E B A L M O R F R E B M U N N O I T A R T S I G E R A I N R O F I L A C / A P E D N A R E R U T C A F U N A M L TOTAL PRODUCT USED NUMBER OF CODE COMMODITY OR SITE ACRES/UNITS D E T A E R T D E T A E R T S N O I T A C I L P P A ) e r u s a e M f o t i n U e n O e l c r i C ( E D O C A H P L A E D U L C N I D E I L P P A T C U D O R P F O E M A N LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA LB OZ PT QT GA 1. Complete Columns A, B, C, and D for All Users 2. Complete Column E by Using One of the Following Codes 3. Complete Columns F and G, if Use Does not Fit one of the Above Codes . s e r u t c u r t s r e h t o d n a s g n i d l i u b n o r o n i h t i w d e m r o f r e p k r o w l o r t n o c t s e p y n a s e d u l c n i l o r t n o C t s e P l a r u t c u r t S - 0 1 e d o C Code 30 - Landscape Maintenance Pest Control includes any pest control work performed on landscape plantings around residences, or other buildings, golf courses, parks, cemetaries, etc. Code 40 - Right-of-Way Pest Control includes any pest control work performed along roadsides, power lines, median strips, ditch banks and similar sites. Code 50 - Public Health Pest Control includes any pest control work performed by or under contract with State or local public health or vector control agencies. r e p u s e h t r e d n u k r o w r o s e i c n e g a c i l b u p y b d e m r o f r e p k r o w l o r t n o c t s e p e t a r b e t r e v y n a s e d u l c n i l o r t n o C t s e P e t a r b e t r e V - 0 8 e d o C vision of the State or county agricultural commissioner. Code 91 - Commodity Fumigation (Nonfood/Nonfeed) includes fumigation of nonfood/nonfeed commodities such as; pallets dunnage, furniture, burlap bags, etc. o f l o r t n o c e h t n i s r o t c a r t n o c r o s e e y o l p m e c i l b u p y b d e m r o f r e p k r o w l o r t n o c t s e p y n a s e d u l c n i l o r t n o C t s e P y r o t a l u g e R - 0 0 1 e d o C regulated pests. STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATION PESTICIDE ENFORCEMENT BRANCH PR-ENF-060(REV. 4/92) G F E D C B A INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW AND ON THE REVERSE SIDE MONTHLY SUMMARY PESTICIDE USE REPORT REPORT PREPARED BY DATE 9 9 9 9 - 9 9 9 ) 0 0 8 ( 5 0 3 2 9 e l l i v r e t n e C . e v A a i n r o f i l a C 4 3 2 1 y n a p m o C t s e P r u o Y 1 2 9 0 0 2 - y r a u r b e F 9 1 s e l e g n A s o L 9 9 9 9 R P 34.00 9 3 - 4 2 6 1 r o b - m i T 8 10 26.00 4 0 2 - 4 4 4 9 0 2 - X P H r e d a v n I 7 10 31.00 7 0 1 - 2 8 1 0 1 C T n o m e D 6 10
Transcript of STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE … · Your Pest Company 1234 California Ave....
03/09/2009
REBMUN ENOHPEDOC PIZYTICSSERDDA)EMAN MRIF( ROTAREPO
OPERATOR IDENTIFICATION/PERMIT NUMBER LICENSE OMREBMUN YTNUOC)DEILPPA EREHW( YTNUOCREBMUN TACILPPA FO REBMUN LATOTESU FO RAEY/HTN IONS
EBAL MORF REBMUN NOITARTSIGER AINROFILAC/APEDNA RERUTCAFUNAM L TOTAL PRODUCT USED NUMBER OF CODE COMMODITY OR SITE ACRES/UNITSDETAERTDETAERTSNOITACILPPA)erusaeM fo tinU enO elcriC(EDOC AHPLA EDULCNIDEILPPA TCUDORP FO EMAN
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
1. Complete Columns A, B, C, and D for All Users2. Complete Column E by Using One of the Following Codes
3. Complete Columns F and G, if Use Does not Fit one of the Above Codes
.serutcurts rehto dna sgnidliub no ro nihtiw demrofrep krow lortnoc tsep yna sedulcnilortnoC tseP larutcurtS -01 edoCCode 30 - Landscape Maintenance Pest Control includes any pest control work performed on landscape plantings around residences, or other buildings, golf courses, parks, cemetaries, etc.Code 40 - Right-of-Way Pest Control includes any pest control work performed along roadsides, power lines, median strips, ditch banks and similar sites.Code 50 - Public Health Pest Control includes any pest control work performed by or under contract with State or local public health or vector control agencies.
repus eht rednu krow ro seicnega cilbup yb demrofrep krow lortnoc tsep etarbetrev yna sedulcnilortnoC tseP etarbetreV -08 edoC vision of the State or county agricultural commissioner.Code 91 - Commodity Fumigation (Nonfood/Nonfeed) includes fumigation of nonfood/nonfeed commodities such as; pallets dunnage, furniture, burlap bags, etc.
of lortnoc eht ni srotcartnoc ro seeyolpme cilbup yb demrofrep krow lortnoc tsep yna sedulcnilortnoC tseP yrotalugeR -001 edoC regulated pests.
STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATIONPESTICIDE ENFORCEMENT BRANCH
PR-ENF-060(REV. 4/92)
GFEDCBA
INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW AND ON THE REVERSE SIDE
MONTHLY SUMMARY PESTICIDE USE REPORT
REPORT PREPARED BY DATE
9999-999 )008(50329ellivretneC.evA ainrofilaC 4321ynapmoC tseP ruoY
129002-yraurbeF91selegnA soL9999 RP
34.0093-4261rob-miT 8 10
26.00402-444902-XPH redavnI 7 10
31.00701-28101CT nomeD 6 10
03/09/2009
REBMUN ENOHPEDOC PIZYTICSSERDDA)EMAN MRIF( ROTAREPO
OPERATOR IDENTIFICATION/PERMIT NUMBER LICENSE OMREBMUN YTNUOC)DEILPPA EREHW( YTNUOCREBMUN TACILPPA FO REBMUN LATOTESU FO RAEY/HTN IONS
EBAL MORF REBMUN NOITARTSIGER AINROFILAC/APEDNA RERUTCAFUNAM L TOTAL PRODUCT USED NUMBER OF CODE COMMODITY OR SITE ACRES/UNITSDETAERTDETAERTSNOITACILPPA)erusaeM fo tinU enO elcriC(EDOC AHPLA EDULCNIDEILPPA TCUDORP FO EMAN
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
1. Complete Columns A, B, C, and D for All Users2. Complete Column E by Using One of the Following Codes
3. Complete Columns F and G, if Use Does not Fit one of the Above Codes
.serutcurts rehto dna sgnidliub no ro nihtiw demrofrep krow lortnoc tsep yna sedulcnilortnoC tseP larutcurtS -01 edoCCode 30 - Landscape Maintenance Pest Control includes any pest control work performed on landscape plantings around residences, or other buildings, golf courses, parks, cemetaries, etc.Code 40 - Right-of-Way Pest Control includes any pest control work performed along roadsides, power lines, median strips, ditch banks and similar sites.Code 50 - Public Health Pest Control includes any pest control work performed by or under contract with State or local public health or vector control agencies.
repus eht rednu krow ro seicnega cilbup yb demrofrep krow lortnoc tsep etarbetrev yna sedulcnilortnoC tseP etarbetreV -08 edoC vision of the State or county agricultural commissioner.Code 91 - Commodity Fumigation (Nonfood/Nonfeed) includes fumigation of nonfood/nonfeed commodities such as; pallets dunnage, furniture, burlap bags, etc.
of lortnoc eht ni srotcartnoc ro seeyolpme cilbup yb demrofrep krow lortnoc tsep yna sedulcnilortnoC tseP yrotalugeR -001 edoC regulated pests.
STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATIONPESTICIDE ENFORCEMENT BRANCH
PR-ENF-060(REV. 4/92)
GFEDCBA
INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW AND ON THE REVERSE SIDE
MONTHLY SUMMARY PESTICIDE USE REPORT
REPORT PREPARED BY DATE
9999-999 )008(50329ellivretneC.evA ainrofilaC 4321ynapmoC tseP ruoY
129002-yraurbeF03ytnuoC egnarO9999 RP
8.0093-4261rob-miT 2 10
53.00402-444902-XPH redavnI 14 10
26.00701-28101CT nomeD 5 10
03/09/2009
REBMUN ENOHPEDOC PIZYTICSSERDDA)EMAN MRIF( ROTAREPO
OPERATOR IDENTIFICATION/PERMIT NUMBER LICENSE OMREBMUN YTNUOC)DEILPPA EREHW( YTNUOCREBMUN TACILPPA FO REBMUN LATOTESU FO RAEY/HTN IONS
EBAL MORF REBMUN NOITARTSIGER AINROFILAC/APEDNA RERUTCAFUNAM L TOTAL PRODUCT USED NUMBER OF CODE COMMODITY OR SITE ACRES/UNITSDETAERTDETAERTSNOITACILPPA)erusaeM fo tinU enO elcriC(EDOC AHPLA EDULCNIDEILPPA TCUDORP FO EMAN
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
1. Complete Columns A, B, C, and D for All Users2. Complete Column E by Using One of the Following Codes
3. Complete Columns F and G, if Use Does not Fit one of the Above Codes
.serutcurts rehto dna sgnidliub no ro nihtiw demrofrep krow lortnoc tsep yna sedulcnilortnoC tseP larutcurtS -01 edoCCode 30 - Landscape Maintenance Pest Control includes any pest control work performed on landscape plantings around residences, or other buildings, golf courses, parks, cemetaries, etc.Code 40 - Right-of-Way Pest Control includes any pest control work performed along roadsides, power lines, median strips, ditch banks and similar sites.Code 50 - Public Health Pest Control includes any pest control work performed by or under contract with State or local public health or vector control agencies.
repus eht rednu krow ro seicnega cilbup yb demrofrep krow lortnoc tsep etarbetrev yna sedulcnilortnoC tseP etarbetreV -08 edoC vision of the State or county agricultural commissioner.Code 91 - Commodity Fumigation (Nonfood/Nonfeed) includes fumigation of nonfood/nonfeed commodities such as; pallets dunnage, furniture, burlap bags, etc.
of lortnoc eht ni srotcartnoc ro seeyolpme cilbup yb demrofrep krow lortnoc tsep yna sedulcnilortnoC tseP yrotalugeR -001 edoC regulated pests.
STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATIONPESTICIDE ENFORCEMENT BRANCH
PR-ENF-060(REV. 4/92)
GFEDCBA
INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW AND ON THE REVERSE SIDE
MONTHLY SUMMARY PESTICIDE USE REPORT
REPORT PREPARED BY DATE
9999-999 )008(50329ellivretneC.evA ainrofilaC 4321ynapmoC tseP ruoY
39002-yraurbeF33ytnuoC edisreviR9999 RP
3.00402-444902-XPH redavnI 1 10
10.00701-28101CT nomeD 2 10
03/09/2009
REBMUN ENOHPEDOC PIZYTICSSERDDA)EMAN MRIF( ROTAREPO
OPERATOR IDENTIFICATION/PERMIT NUMBER LICENSE OMREBMUN YTNUOC)DEILPPA EREHW( YTNUOCREBMUN TACILPPA FO REBMUN LATOTESU FO RAEY/HTN IONS
EBAL MORF REBMUN NOITARTSIGER AINROFILAC/APEDNA RERUTCAFUNAM L TOTAL PRODUCT USED NUMBER OF CODE COMMODITY OR SITE ACRES/UNITSDETAERTDETAERTSNOITACILPPA)erusaeM fo tinU enO elcriC(EDOC AHPLA EDULCNIDEILPPA TCUDORP FO EMAN
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
LB OZ PT QT GA
1. Complete Columns A, B, C, and D for All Users2. Complete Column E by Using One of the Following Codes
3. Complete Columns F and G, if Use Does not Fit one of the Above Codes
.serutcurts rehto dna sgnidliub no ro nihtiw demrofrep krow lortnoc tsep yna sedulcnilortnoC tseP larutcurtS -01 edoCCode 30 - Landscape Maintenance Pest Control includes any pest control work performed on landscape plantings around residences, or other buildings, golf courses, parks, cemetaries, etc.Code 40 - Right-of-Way Pest Control includes any pest control work performed along roadsides, power lines, median strips, ditch banks and similar sites.Code 50 - Public Health Pest Control includes any pest control work performed by or under contract with State or local public health or vector control agencies.
repus eht rednu krow ro seicnega cilbup yb demrofrep krow lortnoc tsep etarbetrev yna sedulcnilortnoC tseP etarbetreV -08 edoC vision of the State or county agricultural commissioner.Code 91 - Commodity Fumigation (Nonfood/Nonfeed) includes fumigation of nonfood/nonfeed commodities such as; pallets dunnage, furniture, burlap bags, etc.
of lortnoc eht ni srotcartnoc ro seeyolpme cilbup yb demrofrep krow lortnoc tsep yna sedulcnilortnoC tseP yrotalugeR -001 edoC regulated pests.
STATE OF CALIFORNIA DEPARTMENT OF PESTICIDE REGULATIONPESTICIDE ENFORCEMENT BRANCH
PR-ENF-060(REV. 4/92)
GFEDCBA
INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW AND ON THE REVERSE SIDE
MONTHLY SUMMARY PESTICIDE USE REPORT
REPORT PREPARED BY DATE
9999-999 )008(50329ellivretneC.evA ainrofilaC 4321ynapmoC tseP ruoY
59002-yraurbeF63onidranreB naS9999 RP
8.0093-4261rob-miT 2 10
9.00402-444902-XPH redavnI 3 10
