Written Permission to Apply Volatile Herbicides Near Sensitive Crops
Written permission is required for any grower that wants to apply volatile herbicides (e.g. 2,4-D, 2,4-DB, MCPA, dicamba, propanil) within the buffer distances designated by the county Agriculture Department and/or by regulations near sensitive crops (cotton, grapes, pistachios, prunes). If you are willing to allow these pesticides to be sprayed within the designated buffer area, fill out this form, and sign below.
I, ______, give permission to ______(Sensitive crop grower) (Permittee) to apply the herbicide(s) ______, to ______(Pesticide(s)) (crop) at site ______,which is within the ______mile buffer of my ______crop (site id) (buffer) (sensitive crop) at site ______, on approximately ______. (site id) (Date)
I fully understand the conditions of application and the nature of the material being applied. I further understand that this written permission does not relieve the Permittee and/or Applicator from compliance with all applicable Federal and State pesticide use laws and regulations.
______Signature Date
4/98 Original: Permittee Copies to: Applicator & Signee
Written Permission to Apply Volatile Herbicides Near Sensitive Crops
Written permission is required for any grower that wants to apply volatile herbicides (e.g. 2,4-D, 2,4-DB, MCPA, dicamba, propanil) within the buffer distances designated by the county Agriculture Department and/or by regulations near sensitive crops (cotton, grapes, pistachios, prunes). If you are willing to allow these pesticides to be sprayed within the designated buffer area, fill out this form, and sign below.
I, ______, give permission to ______(Sensitive crop grower) (Permittee) to apply the herbicide(s) ______, to ______(Pesticide(s)) (crop) at site ______,which is within the ______mile buffer of my ______crop (site id) (buffer) (sensitive crop) at site ______, on approximately ______. (site id) (Date)
I fully understand the conditions of application and the nature of the material being applied. I further understand that this written permission does not relieve the Permittee and/or Applicator from compliance with all applicable Federal and State pesticide use laws and regulations.
______Signature Date
4/98 Original: Permittee Copies to: Applicator & Signee