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.