2014 Monterey County Methyl Bromide Permit Conditions

2014 Monterey County Methyl Bromide Permit Conditions
Monterey County has adopted the buffer zone requirements (Tables 1-5) in the Department of Pesticide
Regulation’s Methyl Bromide Field Soil Fumigation Buffer Zone Determination, Rev. 3/13 as part of our
permit conditions. In limited cases, the buffer zones may be increased due to unique circumstances at a
specific site. A copy of the buffer zone tables can be found at:
http://www.cdpr.ca.gov/docs/emon/methbrom/buffer_determination.pdf
In all cases, the most restrictive requirement must be followed, whether it is the label, regulations, or
Monterey County permit conditions.
When approved, the worksite plan and completed forms become conditions of the restricted
materials permit, along with this document.
Only a California licensed Pest Control Business (PCB) registered in Monterey County to work in Field
Fumigation Pest Control (Subcategory O) is allowed to apply the fumigant.
Applicators must follow the requirements in the Methyl Bromide Phase II labeling, regardless of the
labeling on the MeBr product they will be using. Copies of the Phase II labels can be downloaded at :
http://www.cdpr.ca.gov/docs/emon/fumigants/fum_labels.htm
Throughout this document, whenever the pronoun “you” or “your” is used, it refers to the operator of the
property to be fumigated who is the fumigant permit holder.
You and the PCB are both responsible to comply with all conditions of this permit and with the following
sections from Title 3 California Code of Regulations:
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
6447
Methyl Bromide  Field Fumigation  General Requirements
6447.1 Methyl Bromide Field Fumigation Notification Requirements
6447.2 Methyl Bromide Field Fumigation Buffer Zone Requirements
Failure to comply with permit conditions or fumigation regulations may result in an administrative
penalty consisting of a fine to you and/or the PCB, depending on the circumstances of the violation.
You or your employee representative, who has the authority to control the activities of your employees,
must be present at the fumigation site during the application to supervise your handlers. Your
representative must be trained and equipped as a pesticide handler.
Injection of the fumigant must start after 5:00 a.m. and conclude by 5:00 p.m.
Proposed Worksite Plan
You must submit a proposed Methyl Bromide Worksite Plan to the commissioner for evaluation at least 7
days prior to submitting a notice of intent (9 days before the first application). Submission of incomplete
or problematic proposed worksite plans will delay approval beyond 7 days, which will require
fumigations to be rescheduled. If the proposed worksite plan is incomplete or there are changes that
need to be made, an inspector will contact you for amendments/corrections. You are responsible for
Monterey County Methyl Bromide Permit Conditions 7/11/2014
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notifying the PCB of any changes, amendments or corrections to the worksite plan.
The worksite plan, (including all required calculations, tarp repair response plan, tarp cutting and removal
plan, permissions and notifications), must be submitted on completed Monterey County Methyl Bromide
Worksite Plan forms.
It is critical that the number of acres to be fumigated per block is accurate on the worksite plan in order to
ensure buffer zones are calculated correctly. In order to avoid possible buffer zone or notification
violations if you are estimating the actual acreage, you should over estimate rather than underestimate.
General Buffer Zone Requirements
The inner and outer buffer zones mentioned in 3 CCR section 6447.2 must extend outward from the edge
of the application block perimeter equally in all directions. All non-handlers, including field workers,
residents, pedestrians, and other bystanders, must be excluded from the inner buffer zone during the
buffer zone period. The buffer zone restrictions begin at the start of fumigation. The buffer zone
restrictions remain in effect for at least 48 hours after the completion of the application to the application
block. None of the buffer zone credits described on the label can be used for methyl bromide.
Inner Buffer Zone (IBZ)
The operator of the property to be treated shall assure that no persons are allowed within the IBZ
mentioned in 3 CCR section 6447.2 except to transit by vehicle or bicycle and perform fumigationhandling activities. The IBZ cannot extend into residential properties at any time, no exceptions. IBZs
must not contain bus stops or other locations where people routinely wait for transit. Inner buffer zones
must not include buildings under the control of the owner of the application block and used for storage
(e.g., sheds, barns, garages), UNLESS,
1. The storage buildings are not occupied during the buffer zone period, and
2. The storage buildings do not share a common wall with an occupied structure.
Inner Buffer Zone Posting
The IBZ may extend into adjoining agricultural property only if the adjoining property operator gives
written permission and allows the operator of the property to be treated to post the IBZ boundary on the
adjoining property with signs.
Unless there is a physical barrier that prevents bystander access to the IBZ, inner buffer zone signs must
also be placed along or outside the perimeter of the IBZ, at all usual points of entry, and along likely
routes of approach from areas where people not under the owner's control may approach the buffer zone.
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Some examples of points of entry include, but are not limited to, roadways, sidewalks, paths, and
bike trails.
Some examples of likely routes of approach include, but are not limited to, the area between a
buffer zone and a roadway, or the area between a buffer zone and a housing development.
Signs placed along the perimeter of the IBZ must be posted at intervals not exceeding 200 feet.
IBZ signs must be posted before the fumigation begins.
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When an IBZ must be posted you (property operator) and the PCB are both responsible for ensuring the
boundary of the IBZ is posted with warning signs.
You must maintain the signs so that they are upright and legible from a distance of 25 feet for the duration
of the buffer zone, and you must remove the signs within 3 days (72 hours) after the expiration of the
buffer zone period.
IBZ signs must meet the following criteria:
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The printed side of the sign must face away from the application block toward areas from which
people could approach.
Signs must remain legible during the entire posting period and must meet the general standards
outlined in the WPS for sign size, text size, and legibility (see 40 CFR §170.120).
Signs must be posted no sooner than 24 hours prior to the start of the application and remain
posted until the buffer zone period has expired.
Signs must be removed within 3 days after the end of the buffer zone period.
The IBZ signs must contain the following information:
o “Do Not Walk” symbol
o DO NOT ENTER/NO ENTRE
o Methyl Bromide [Product Name] Fumigant BUFFER ZONE
o Contact information for the certified applicator in charge of the fumigation
Exception: If multiple contiguous blocks are fumigated within a 14-day period, the entire periphery of the
contiguous blocks' buffer zones may be posted. In this case, the entire periphery must be posted no
sooner than 24-hours prior to the start of the first application. The signs must remain posted until the last
buffer zone period expires and signs must be removed within 3 days after the buffer zone period for the
last block has expired.
Outer Buffer Zone (OBZ)
The outer buffer zone shall be at least 60 feet. The operator of the property to be treated shall assure that
no persons are allowed within the outer buffer zone except to transit, perform fumigation-handling
activities, general farming activities, outdoor industrial activities or outdoor domestic chores. In no
instance shall persons be allowed within the outer buffer zone for more than 12 hours in a 24-hour period.
The outer buffer zone shall not extend into properties that contain schools, convalescent homes, hospitals,
and other similar sites determined by the commissioner.
Outer buffer zones must not include residential areas (e.g., employee housing, private property), buildings
(e.g., commercial, industrial), outdoor residential areas (e.g., lawns, gardens, play areas) and other areas
that people may occupy, UNLESS,
 The occupants provide written permission for the OBZ to encroach on their property prior to the
application and
 Reentry by occupants and other non-handlers must not occur until,
o The buffer zone period has ended, and
o Sensory irritation is not experienced upon re-entry.
o For products containing more than 89% of methyl bromide, the certified applicator or
handler(s) under his/her supervision has monitored the structures and has not experienced
Monterey County Methyl Bromide Permit Conditions 7/11/2014
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any sensory irritation upon re-entry. Entry by occupants and other non-handlers must not
occur until two consecutive air samples for methyl bromide have been taken in the structure
at least 1 hour apart and both samples indicate less than 1 ppm methyl bromide.
For publicly owned and/or operated areas such as parks, sidewalks, permanent walking paths,
playgrounds, and athletic fields, outer buffer zones must not include these areas, UNLESS,
1. The area is not occupied during the buffer zone period,
2. Entry by non-handlers is prohibited during the buffer zone period, and
3. Written permission to include the public area in the buffer zone is granted by the appropriate state
and/or local authorities responsible for management and operation of the area.
Initial Notification
The certified applicator supervising the fumigation and the operator of the property to be treated shall
assure that operators of the following properties within 300 feet of the perimeter of the outer buffer zone
receive initial notification that a permit to use methyl bromide near their property has been issued by the
commissioner: properties that contain schools, residences, hospitals, convalescent homes, onsite
employee housing, or businesses.
Initial notification must be in writing on a completed Monterey County notification form. In the blank,
“Fumigation location” on the form, you must write in the location of the application block, not just the
name of the ranch. If necessary attach a map to the form so the person receiving the notice can
understand where the fumigation will actually occur.
You must give initial notification to nearby property operators as early as possible but at least 9 days
before the proposed fumigation date. Your contact information on the notification letter must be current
and include a phone number where a voice mail message may be left. The proposed dates must be as
accurate as possible, and the earliest and latest dates that the fumigation will start must not range
more than 4 weeks.
To accommodate those who may call with questions or who want to request specific 48 hour notification,
you must list a contact for both English and Spanish speakers on the form. The individual or voice mail
designated as the contact must be fluent in the language indicated next to their name on the form.
You must keep a log of the initial notifications on the Monterey County Methyl Bromide notification log
form. Columns A, B, C, D, & E of the log must be completed and submitted before the worksite plan is
approved.
Difficult to Evacuate Sites
No fumigant application with an outer buffer zone greater than 300 feet is permitted within 1/4 mile
(1,320 feet) of the property line of difficult to evacuate sites unless the site is not occupied by children
from state-licensed day care centers, students (pre-K to grade 12), patients, or prisoners during the
application and the 36-hour period following the end of the application.
No fumigant application with an outer buffer zone of 300 feet or less is permitted within 1/8 mile (660
feet) of the property line of difficult to evacuate sites unless the site is not occupied by children from
state-licensed day care centers, students (pre-K to grade 12), patients, or prisoners during the application
and the 36-hour period following the end of the application.
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Encroachment and Vacating Agreements
If the IBZ or OBZ extends into an adjoining property not under your direct control, a completed, signed
and initialed Outer Buffer Zone and/or Inner Buffer Zone Encroachment Agreement from the operator of
the adjoining property must be submitted as part of the worksite plan. You are responsible to make sure
that the person signing the form understands his/her responsibilities. A copy of the encroachment
agreement must be left with the person who signed the form.
If a head of household agrees to vacate a residence in order to allow an OBZ to extend into the area that
contains the residence, a completed, signed and initialed Residential Encroachment / Vacating Agreement
from the head of household of the residence to be vacated must be submitted as part of the worksite plan.
You are responsible to make sure that the person signing the form understands his/her responsibilities. A
copy of the agreement must be left with the person who signed the form. In this case a separate
encroachment agreement does not need to be signed and submitted.
If there is a house on adjacent agricultural property the IBZ cannot encroach into the yard unless there is a
completed, signed and initialed Agricultural Property Encroachment / Vacating Agreement from the head
of household of the residence to be vacated, then the IBZ may go up to the structure walls. A copy of the
agreement must be left with the person who signed the form. In this case a separate encroachment
agreement does not need to be signed and submitted unless the property includes agricultural fields under
the control of the head of household of the residence to be vacated.
Maps
A complete legible aerial map showing an outline of the proposed application block and surrounding
areas must be submitted as part of the worksite plan. The map must identify adjacent property operators.
Neighboring properties requiring notification and/or signed agreements must be numbered to correspond
with the notification log. Measurements must be made from the edge of the field to be fumigated to the
property lines of all the surrounding properties. These measurements must be on the map. If a portion of
a residential property is to be used as part of the outer buffer zone, the distance to the residence must be
included. Maps must also include locations of difficult to evacuate sites within ¼ mile of the application
block; distances to bus stops, roadways, right-of-ways, walking paths; sidewalks; lakes; waterways; and
wells.
Specific Notification
You must assure that specific notification of the date and time of the start of the fumigation and
anticipated expiration of buffer zones is provided to those persons who request specific fumigation
information, and those who signed a written encroachment agreement.
This specific fumigation notification must be provided at least 48 hours prior to starting the fumigation. If
a request for specific notification is received after the submission of the notice of intent and before the
fumigation begins, the specific fumigation notification shall be provided prior to starting the fumigation,
but the 48-hour requirement shall not apply.
If the fumigation of an application block does not start within 12 hours of the starting time on the Notice
of Intent (NOI), a new specific notification must be provided to those persons who requested a specific
notification and those who signed a written encroachment agreement. Failure to do this will delay the
application.
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Notice to Vacate
At least 48 hours prior to starting the fumigation, you must provide a completed Notice to Vacate form to
all persons who have provided you with a signed Vacating Agreement. A copy of the signed Notice to
Vacate must be submitted with your Notice of Intent.
Weather
Field fumigations should not commence if the weather forecast for the day of the fumigation and 48 hours
following the fumigation indicate any of the following:
o the air temperature in the vicinity of the fumigation will be above 85°F,
o wind speeds will drop below 3 mph for 5 or more consecutive hours,
o wind speeds will rise above 20 mph.
You can find this information at The National Weather Forecast Office: http://www.wrh.noaa.gov/mtr/
Notices of Intent (NOIs)
NOIs must be submitted at least 48 hours* prior to the start of the application. No waivers of the 48 hour
NOI requirement will be granted. *For any applications within 1/4 mile (1320 feet) of a Pajaro Valley
School District school or North Monterey County School District school, the NOI must be submitted 72
hours before the intended application.
In addition to the standard information required by regulation, the following information must be included
on or submitted with the NOI:

The number of application blocks to be treated and acreage of each block.

The hour fumigant injection will start.
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The fumigation method (e.g., tarp/shallow/broadcast [3B1])
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Type of tarp that will be used.
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A clear, complete and accurate aerial map of the fumigation site showing:
— Outline of the proposed application block(s) with size in acres.
— Identification of adjacent property operators.
— Areas within the application block(s) that will not be fumigated.
— IBZ & OBZ size for each block.
— Areas where the buffer zone encroaches onto property not operated by the operator of
the property to be fumigated with distances identified in feet.
— Structures that will be vacant or vacated for the fumigation
o Numbers on map must correspond to Monterey County Encroachment and
Vacating Agreements and Notification Log (as applicable).
— Locations of difficult to evacuate sites within ¼ mile (1320 feet) of the fumigation
blocks.
— All occupied structures and bystander areas within 300 feet of the perimeter of the outer
buffer zone.
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— Distances must indicate where the measurements were taken.

A copy of each Notice to Vacate.
For a Sunday or Monday fumigation, an NOI must be submitted no later than noon on the Thursday
before.
The fumigation must not commence sooner than the intended starting time or later than 12 hours after the
starting time specified on the NOI.
If fumigation of an application block does not commence within 12 hours of the time specified in the
NOI, the NOI must be re-submitted with the new dates and/or times.
Changes to the NOI must be made in writing, either in person or by fax. Inspectors will not alter or
change the information on the NOI.
When an NOI is re-submitted because of a change, rescheduling, or to finish a job, the 48 hour waiting
period will be waived provided there are no vacating or encroachment agreements associated with the
application, and the applicator re-submits the NOI prior to commencing the fumigation. The re-submitted
NOI must clearly indicate that it is a re-intent.
If there are encroachment or vacating agreements associated with the fumigation, the 48 hour waiting
period will not be waived unless all notifications to affected persons have been updated.
For multiple application blocks to be fumigated sequentially, one NOI with a schedule may be submitted.
The schedule must specify the date and time each application block is intended to be
fumigated. Twelve hours must elapse from completion of the earlier application, until the start of
injection of the next application if the buffers will overlap.
Submitting NOI Maps via Email
There are three e-mail addresses where growers, PCB’s and/or PCA’s may send NOI maps to our offices.
We are not currently set up to receive entire NOI’s via e-mail, only the maps.
NOIs and re-NOIs must be submitted in person or via fax. Due to the poor quality of faxed map images,
when you fax an NOI, you must either deliver a hard copy of the map, or e-mail the map to the
appropriate office. Please make sure the map is sent or delivered to the same office as the accompanying
NOI. For fumigations south of Soledad, NOIs and maps should be sent to the King City office. For
fumigations north of Meridian Road in Prunedale and north of Dolan Road, NOIs and maps should be
sent to the Pajaro office. Everything else should be sent to Salinas.
Please indicate on the NOI (or re-NOI) that the map was e-mailed separately. Write this information
directly on the NOI itself or attach a separate page indicating the map was e-mailed. Failure to notify us
in the fax that you are e-mailing the map separately may cause us to delay your job.
When e-mailing a map, the subject line of the e-mail must contain:
Grower Name, Ranch Name and Recommendation Number
Monterey County Methyl Bromide Permit Conditions 7/11/2014
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The e-mail addresses are:
[email protected]
[email protected]
[email protected]
Re-Treatment Notification
The Monterey County Agricultural Commissioner’s office must be notified prior to retreating any portion
of a previously-treated field.
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The notification shall be either oral, in writing or both and include the location, the specific date
and time of re-treatment and the fumigant(s) to be used.
As soon as possible, the NOI for the original job must be re-submitted to our office. The resubmitted NOI must clearly indicate that it is a re-treat.
Pesticide use reports for the re-treatment shall be completed and submitted to our office, and may
be marked “re-treat”.
Tarps
Tarps listed by the USEPA as qualifying for a 60% reduction in buffer zone distance may be used;
however, none of the buffer zone credits described on the label apply to methyl bromide fumigations in
Monterey County. A list of these tarps can be found on the U.S. EPA website at
http://www.epa.gov/pesticides/tarpcredits/ under “Methyl Bromide and Chloropicrin, 60% reduction in
buffer zone distance”. If tarps on the USEPA 60% buffer zone reduction list are used, they must not be
perforated until a minimum of 9 days (216 hours) have elapsed after the application is complete.
According to the fumigant labeling tarps may be removed early if a weather condition exists which
necessitates early tarp perforation or removal, however in Monterey County no tarps may be removed
early regardless of weather conditions without prior approval of the Monterey County Agricultural
Commissioner’s office.
The use of metalized tarps is not allowed. The use of embossed tarps is not allowed, unless the tarps are
on the USEPA 60% buffer zone reduction list.
Site Monitoring Requirement Based on Type of Tarp Used
If high barrier tarp that does not qualify for a buffer zone reduction is used, the property operator must
assure that a trained handler continuously monitors the entire periphery of the inner buffer zone between
the hours of 4:00 am and 9:00 am, starting the morning after the fumigation and every morning until the
expiration of the buffer zone. During that time the monitor must take a reading of air temperature, wind
speed and direction, every 30 minutes and use the Post Application Monitoring Form provided by our
office to record readings and comments about conditions at the field.
Sensory Irritation Response
If at any time, sensory irritation is experienced by anyone, the following measures must be taken:
 All persons within 1,500 feet of the application block must be evacuated from the area
Monterey County Methyl Bromide Permit Conditions 7/11/2014
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immediately.
The Monterey County Agricultural Commissioner’s office must be notified as soon as possible but
no longer than 60 minutes after sensory irritation is experienced.
No person other than a correctly trained and PPE-equipped methyl bromide fumigant handler will
be allowed within 1,500 feet of the application until wind speed in the vicinity of the fumigated
field rises above 4 mph for thirty minutes.
The Post Application Monitoring Form provided by the Monterey County Agricultural
Commissioner must be used to record readings and specific details about all actions taken to
ensure all persons within 1,500 feet of the application block were evacuated.
Tarp Cutting and Removal
When you hire a Tarp Cutting and Removal Company to cut and remove fumigation tarps, you and the
Tarp Cutting and Removal Businesses share responsibility for compliance with Tarp Cutting & Removal
conditions of this permit and with the following sections of Title 3 California Code of Regulations:

6447.3(a)(3) Methyl Bromide Field Fumigation Methods
(F) The tarpaulin shall not be cut until a minimum of five days (120 hours) following
completion of injection to the application block. The tarpaulin shall be cut pursuant to
section 6784(b)(4).
(G) Tarpaulin removal shall begin no sooner than 24 hours after tarpaulin cutting has been
completed.
(H) The application block restricted entry interval shall end at completion of tarpaulin
removal, and shall be at least six days.

6784 (a) Field Fumigation. Signs required to be posted in accordance with section 6776(f) shall
remain in place until aeration is complete.

6784 (b)(4) Tarpaulin Cutting and Removal Procedures
(A) Tarpaulin cutting and tarpaulin removal shall be discontinued if the presence of gas is
readily evident (onset of eye irritation or odor).
(B) Tarpaulins used for broadcast fumigations shall be cut using only mechanical methods
including all-terrain vehicle or a tractor with a cutting wheel. Each tarpaulin panel used
for broadcast fumigations shall be cut lengthwise.
Failure to comply with permit conditions or fumigation regulations may result in an administrative
penalty consisting of a fine to either you and/or the tarp cutting and removal businesses, depending on the
circumstances of the violation.
Notification to Tarp Cutters and Pullers
You or your authorized representative must notify the tarp pulling company of the date and exact time when the
tarps can be cut.
Tarp Repair Response Plan
The PCA’s phone number listed on the plan as contact to report evidence of excessive gas escaping or
about to escape from the tarp must be a number where the PCA can be reached 24 hours a day, seven days
a week.
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County Use Only
METHYL BROMIDE WORKSITE PLAN
Date Received:
_________/__________/__________
MONTEREY COUNTY
Time Received:
________:________ a.m.
p.m.
Biologist: ________________
Property Operator:
Permit Number:
Site ID Number:
Ranch Name & Lot #:
Pest Control Business:
PCA:
Fumigation Method:
Application Rate:
Total Number of Acres to be Fumigated:
Type of Tarp to be used:
Contact your PCB to get the information to determine the buffer zones. All properties within 300 feet
of the perimeter of the outer buffer zone must receive initial notification. Use the following table to
record the calculations. Please list blocks in proposed sequence of treatment.
NUMBER OF ACRES
TO BE FUMIGATED
PER BLOCK
Overlapping BZ
< 36 Hrs Apart
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Neighbor Notification:  N/A
RATE
LBS/AC
% MB
EMISSION
RATIO
EMISSION
RATE
INNER
BUFFER
ZONE
OUTER
BUFFER
ZONE
NOTIFICATION REQ
(OUTER BUFFER
ZONE + 300 FEET)
 Yes - 4 week window: _________________________________________
It is critical that the number of acres to be fumigated per block is accurate on the worksite plan in order to
ensure buffer zones are calculated correctly. In order to avoid possible buffer zone or notification violations
if you are estimating the actual acreage, you should over estimate rather than underestimate.
Worksite Plan Approved by:
Date of Approval:
MB Permit Supplement Issued by:
Date:
Do Not Submit Without The Following Attachments:
Map
Notification Log
Tarp Repair &
Cutting Plan
Work Hour Restrictions &
Respiratory Protection Plan
SUBMISSION OF INCOMPLETE OR PROBLEMATIC WORKSITE PLANS WILL DELAY APPROVAL
BEYOND 7 DAYS, WHICH MAY REQUIRE RESCHEDULING YOUR FUMIGATIONS.
Monterey County Methyl Bromide Worksite Plan
7/11/2014
WORK HOUR RESTRICTIONS AND RESPIRATORY
PROTECTION PLAN
As shown in the following chart, work hours for each fumigation handling activity varies with the type of
respiratory protection and the number of workdays in a calendar month.
Number of Workdays in a Calendar Month
Respirator Type
More than 3 days
3 days or less
None
Not Allowed
Table 2 work hours*
Half-face
Table 1 work hours*
No work hour limits
Full-face/SCBA/supplied air
No work hour limits
No work hour limits
* See 3 CCR section 6784(b)(3) for Table 1 and Table 2
Based on: (1) the amount of Methyl Bromide to be applied, (2) use of respiratory equipment, and (3) the
employee’s previous work history, the following handlers will be subject to the following work hour
limitations:
Occupation
Working more
than 3 days in 30
Wearing full-face
respirator
With half-face
respirator
Without halfface respirator
Driver
Yes
No
No Limit
____ hours
____ hours
Co-Pilot
Yes
No
No Limit
____ hours
____ hours
Shoveler
Yes
No
No Limit
____ hours
____ hours
Supervising
Yes
No
No Limit
____ hours
____ hours
Tarp Cutter
Yes
No
No Limit
____ hours
____ hours
Tarp Remover
Yes
No
No Limit
No Limit
____ hours
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All time spent in the field being fumigated or within the inner buffer zone counts towards
the work hour limits. Activities or time spent outside the inner buffer zone does not count
toward the work hour limits.

Respirator cartridges must be changed after one day’s use (daily) or shift, whether it is used
for one hour or eight hours during the employee’s work shift.
Monterey County Methyl Bromide Worksite Plan
7/11/2014
TARP REPAIR RESPONSE PLAN
DURING fumigation injection, the tarp will be repaired by:
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The PCB
I or my trained employees
An authorized representative:_______________________________________
NAME
AFTER the PCB has finished the application and left the field, the field will be monitored for damage by:

The PCB

I or my trained employees

An authorized representative:_______________________________________
NAME
The field will be monitored for problems or damage DURING THE FIRST 24 HOURS:


Hourly
Every two hours
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Every four hours
Every six hours
Other
Decisions for repairing the tarp will be made by myself and the PCB, and will be based on the hazard to the
public, residents or workers, the proximity to occupied structures, the size of the damaged area, the timing of
the damage, the feasibility of repair, and environmental factors such as wind speed and direction.
THE REPAIR RESPONSE TIME IS:
REPORTING:
Any evidence of excessive gas escaping, or about to escape from the tarp, will be immediately
evaluated and immediately reported to both the PCA (by calling active 24/7 number:
)
and the Monterey County Agricultural Commissioner’s Office (by calling Salinas (831) 759-7340, Pajaro
Branch (831) 724-5025 or King City Branch (831) 385-5266).
Evidence Of Excessive Gas Escaping, Or About To Escape From The Tarp Includes:
 A Hole Or Rip In The Tarp – During the first 24 hours, a hole or tear in the tarp that is larger than 6
inches, and is within 100 feet of a property containing an occupied residence will be immediately
reported. After the first 24 hours & until the tarp is cut and removed, any damage larger than 6 feet will
be reported.
 Complaints From Neighbors That They Are Experiencing Symptoms Of Gas Exposure – All complaints
will be immediately reported.
 I or My Employees Experiencing Any Symptoms – All symptoms must be immediately reported.
TARP CUTTING:
The tarps cannot be cut by hand. The following equipment will be used for cutting the tarps (either an
all-terrain vehicle or a tractor with a cutting wheel):
The tarp will be cut and removed according to the conditions and regulations by:
 Tarp Removal Company Name:
Phone No.:
Contact Person:

Grower and the Grower’s Employees

Other
Monterey County Methyl Bromide Worksite Plan
7/11/2014
Monterey County Methyl Bromide Worksite Plan
7/11/2014
Date of Delivery of this Notice:
NOTIFICATION of FIELD FUMIGATION in
MONTEREY COUNTY
You have received this notice because your property is near a farm field that will be treated with a soil fumigant.
Fumigation location:
Nearest cross streets:
Fumigant to be applied:
EPA Registration Number:
Time period when the fumigation is to take place:
Fumigating grower (property operator):
Address:
Phone number:
Fumigation Company:
Address:
Phone number:
For more information or to request specific notification about the exact date and time of the
fumigation(s) and the expiration of the buffer zones please contact:
English
Name
Phone
Nombre
Teléfono
Spanish
Early signs and symptoms of exposure to the fumigant(s):
What to do and who to call if you believe you are being exposed to the fumigant(s) :
You can find additional information about fumigants on the following websites:
US EPA - http://www.epa.gov/oppsrrd1/reregistration/soil_fumigants/
DPR Fumigant Resource Center - http://www.cdpr.ca.gov/docs/emon/methbrom/mb_main.htm
For information regarding the grower’s permit, contact the Monterey County Agricultural Commissioner:
Pajaro
417-A Salinas Road
Watsonville
(831) 724-5025
Salinas
1428 Abbott Street
Salinas
(831) 759-7340
King City
522 North 2nd Street
King City
(831) 385-5266
Date of Delivery of this Notice:
NOTIFICACIÓN DE FUMIGACIÓN DEL CAMPO EN
EL CONDADO DE MONTEREY
Usted ha recibido esta notificación porque su propiedad está cercana a un campo que será tratado con un
fumigante del suelo.
Lugar de la fumigación:
Calles más cercanas:
Fumigante a aplicar:
Número de registro de la EPA:
Período de tiempo de la fumigación:
Operador de la propiedad:
Dirección:
Número telefónico:
Compañía de fumigación:
Dirección:
Número telefónico:
Para más información o para solicitar una notificación específica de la fecha exacta y la hora de la
fumigación (o las fumigaciones) y el vencimiento de las zonas de amortiguamiento, por favor contacte a:
Inglés
Nombre
Número telefónico
Nombre
Número telefónico
Español
Síntomas iniciales de exposición al fumigante (o a los fumigantes):
Qué hacer y a quién llamar si Usted cree que está siendo expuesto al fumigante (o a los fumigantes):
Usted puede encontrar información adicional sobre fumigantes en los siguientes sitios de internet:
US EPA - http://www.epa.gov/oppsrrd1/reregistration/soil_fumigants/
DPR Fumigant Resource Center - http://www.cdpr.ca.gov/docs/emon/methbrom/mb_main.htm
Para información sobre el permiso del productor, contacte al Comisionado de Agricultura del Condado de
Monterey:
Pajaro
417-A Salinas Road
Watsonville
(831) 724-5025
Salinas
1428 Abbott Street
Salinas
(831) 759-7340
King City
522 North 2nd Street
King City
(831) 385-5266
METHYL BROMIDE NOTIFICATION LOG
FUMIGATION DATES ON INITIAL NOTIFICATION: Earliest date of fumigation:
Page 1 of ______
Latest date of fumigation
A
B
C
D
E
F
G
H
I
NUMBER
ON MAP
ADDRESS OR LOCATION
DESCRIPTION
(NAME AND PHONE IF
AVAILABLE)
DATE OF
INITIAL
NOTICE
METHOD OF INITIAL
NOTICE
PERMISSION TO USE
PROPERTY (INNER OR
OUTER)
REQUESTING
SPECIFIC
NOTICE
METHOD
REQUESTED FOR
NOTIFYING
DATE OF
SPECIFIC
NOTICE
METHOD OF SPECIFIC
NOTIFICATION
(Y / N)
(# IF BY PHONE)
(mail, door hanger, in
person)
Inner
1
N/A
Outer
Inner
2
No
N/A
Outer
Inner
3
Inner
N/A
Inner
N/A
Inner
N/A
Inner
Outer
Monterey County Methyl Bromide Notification Log
7/11/2014
Yes
No
N/A
Outer
7
Yes
No
Outer
6
Yes
No
Outer
5
Yes
No
Outer
4
Yes
Yes
No
N/A
Yes
No
(mail, door hanger, in
person, phone)
MeBr NOTIFICATION LOG CONTINUED
Page _____ of _____
A
B
C
D
E
F
G
H
I
NUMBER
ON MAP
ADDRESS OR LOCATION
DESCRIPTION
(NAME AND PHONE IF
AVAILABLE)
DATE OF
INITIAL
NOTICE
METHOD OF INITIAL
NOTICE
PERMISSION TO USE
PROPERTY (INNER OR
OUTER)
REQUESTING
SPECIFIC
NOTICE
METHOD
REQUESTED FOR
NOTIFYING
DATE OF
SPECIFIC
NOTICE
METHOD OF SPECIFIC
NOTIFICATION
(Y / N)
(# IF BY PHONE)
(mail, door hanger, in
person)
Inner
N/A
Outer
Inner
No
N/A
Outer
Inner
N/A
N/A
N/A
Outer
Monterey County Methyl Bromide Notification Log
7/11/2014
Yes
No
N/A
Outer
Inner
Yes
No
Outer
Inner
Yes
No
Outer
Inner
Yes
No
Outer
Inner
Yes
Yes
No
N/A
Yes
No
(mail, door hanger, in
person, phone)
Number on Map/Notification Log:
Methyl Bromide INNER BUFFER ZONE Encroachment Agreement
Agricultural Property Only
I give my permission to
\
Fumigating Permittee
Monterey County RM Permit No.
to extend the inner buffer zone of the proposed methyl bromide fumigation onto my property.
I understand that the fumigating permittee will notify me, at least 48 hours before the fumigation, of the
specific date and time of the start of the fumigation; which areas of my property are affected and the date
& time of the anticipated expiration of the buffer zone.
I will allow the fumigating permittee to post the inner buffer zone boundary on my property with
warning signs. I will be responsible to make sure that no one is allowed in the inner buffer zone
on my property.
I understand and will inform my employees that if at any time while the tarps are on the field,
sensory irritation is observed by any person in the vicinity, my employees must evacuate the area.
1. I will notify any employees who are working on my property that a buffer zone has been
established on the property, and I will inform them of the specific date and time of the start of the
fumigation; the anticipated expiration of the buffer zone; symptoms of sensory irritation; and steps
to take if anyone experiences symptoms of sensory irritation. This includes my employees,
employees of licensed pest control businesses, and employees of farm labor contractors
whether hired by me or by a packer, shipper, processor, or broker to harvest crops on my
property.
2. I will provide this notice before the employees begin work activity on the property where a buffer
zone has been established.
3. I can notify employees of a Farm Labor Contractor (FLC) or Pest Control Business (PCB) by
giving written notice (containing the information in 1. above) to the FLC or PCB. I must inform
the FLC or PCB that they are required to give the notice to their employees.
I understand that if I fail to do the items to which I have agreed the Agricultural Commissioner’s
office may take an enforcement action against me for violation of the conditions of the
fumigating property operator’s restricted material permit. I certify that I received a copy
of this document for my records.
Property Operator
Granting Permission
Print Your Name
Ranch Name
Signature
Date
Address
Phone Number
7/11/2014
Fax Number
A copy of this notice must be provided to the operator/occupant of the property granting permission.
Submit a signed copy to the county with your work site plan.
Numero en el Mapa/Registro de Notificación:
Permiso Para Que La Zona restringida AREA INTERNA De Bromuro De Metilo Se
Extienda A Una Propiedad Agricola Adyacente
Yo doy permiso a
Empresa o persona quien fumigará la propiedad de la persona que tiene el permiso
para extender el área INTERNA de la zona restringida dentro de mi propiedad, durante la fumigación
propuesta de Bromuro de Metilo.
Yo entiendo que la persona que tenga el permiso de fumigación me notificará, por lo menos 48 horas
antes de la fumigación, de la fecha y hora específicada en que la fumigación empiece, así como también
de la fecha de expiración de la zona restringida; qué áreas de mi propiedad se vean afectadas y la fecha y
hora de vencimiento anticipado de la zona restringida.
Doy mi autorización para que el titular del permiso de la fumigación marque la zona restringida interna en
mi propiedad con señales de advertencia. Yo seré responsable de asegurarme de que a nadie se le
permita estar dentro del área interna de la zona restringida, la cual se encuentra en mi propiedad.
Entiendo y le informaré a mis empleados que si en algún momento, mientras que las el plástico esté en el
campo, la irritación sensorial es observado por cualquier persona en la vecindad, mis empleados deben
evacuar el área.
1. Notificaré a cualquier empleado que está trabajando en mi propiedad que una zona de protección se
ha establecido en la propiedad, y les informaré de la fecha y hora especificada del inicio de la
fumigación; del vencimiento anticipado de la zona de amortiguamiento; síntomas de irritación
sensorial; y los pasos a seguir si alguien experimenta síntomas de irritación sensorial. Esto incluye
mis empleados, los empleados de las empresas de control de plagas con licencia, y los
empleados de los contratistas de mano de obra agrícola si contratado por mí o por un
empacador transportador procesador, o cualquier otra persona/ compañía que levante la
cosecha en mi propiedad.
2. Voy a ofrecer este aviso antes de que los empleados comiencen la actividad laboral en la propiedad
donde se ha establecido una zona de protección.
3. Puedo notificar a los empleados de un Contratista de Trabajo Agrícola (FLC) o plagas de negocio de
control (PCB), notificando por escrito (que contiene la información de 1. Anterior) a la FLC o PCB.
Debo informar a la FLC o PCB que están obligados a dar aviso a sus empleados.
Yo entiendo que si yo fallo en realizar los puntos anteriores acordados, el Comisionado de
Agricultura puede tomar una acción de cumplimiento en contra mía. Certifico que he recibido
una copia de este documento para mis archivos.
Operador de la Propiedad
Que otorga el Permiso:
Nombre en letra de imprenta
Firma
Localización:
7/11//2014
Nombre de Rancho
Fecha
Teléfono:
Fax:
Una copia de esta notificación deberá ser proporcionada al operador / ocupante de la concesión de permisos de propiedad. Enviar una
copia firmada a la provincia con su plan de trabajo.
Number on Map/Notification Log:
Agricultural Property Vacating Agreement
for Methyl Bromide Inner Buffer Zone
I give my permission to
\
Fumigating Permittee
Monterey County RM Permit No.
to extend the inner buffer zone of the proposed methyl bromide fumigation at
Location of property to be fumigated
onto my property.
I agree to move out of my residence during the time of the fumigation so that the inner buffer zone can
extend onto my property.
I will allow the fumigating permittee to post the inner buffer zone boundary on my property with warning
signs. I will be responsible to make sure that no one is allowed in the buffer zone which is on my
property.
I understand that I must be out of my residence and off of my property for
hours.
I understand that the fumigating permittee will notify me at least 48 hours before the fumigation, of the
specific date and time of the start of the fumigation, which areas of my property are affected and the date
and time of the anticipated expiration of the buffer zone.
I understand that during the time I agree to be out of my house I may return to my property provided I do
not enter any structures or areas of my property that are within the buffer zone.
I understand that if I fail to do the items to which I have agreed, the Agricultural Commissioner’s
office may take an enforcement action against me for violation of the conditions of this restricted
material permit.
I have read and understand these requirements, and agree to comply with them.
Vacating
Property Operator:
Print Name
Signature
Date
Phone Number:
7/11/2014
A copy of this notice must be provided to the operator/occupant of the property granting permission.
Submit a signed copy to the county with your work site plan.
Number on Map/Notification Log:
Propiedad Agricola / Acuerdo para Extender la Zona Restringida AREA
INTERNA de Bromuro de Metilo y Desocupar la Propiedad
Doy mi permiso a
/
Empresa o persona autorizada para fumigar
Núm. De su permiso de materiales restringidos
Del Condado de Monterey
Para extender la zona restringida área interna de la fumigación de bromuro de metilo propuesta en
en mi propiedad.
Dirección de la propiedad que se fumigará
Estoy de acuerdo en salir de mi residencia durante el tiempo de la fumigación de manera que la zona
restringida interna puede penetrar en la zona donde se encuentra mi propiedad.
Dejaré que la persona/ranchero autorizado para fumigar coloque señales de advertencia. Yo seré
responsable de asegurarme de que a nadie se le permita estar dentro del área interna de la zona
restringida, la cual se encuentra en mi propiedad.
Yo entiendo que tengo que estar fuera de mi residencia durante
horas.
Iniciales aquí
Entiendo que el autorizado para fumigar me notificará por lo menos 48 horas antes de la fumigación, la
fecha y la hora especificada de inicio de la fumigación, que se ven afectadas las áreas de mi propiedad y
la fecha y hora de vencimiento anticipado de la zona restringida.
Entiendo que durante el tiempo Estoy de acuerdo en estar fuera de mi casa puedo regresar a mi propiedad a
condición de que no entren en las estructuras o áreas de mi propiedad que se encuentran dentro de la zona
restringida interna.
Entiendo que si no cumplo con los artículos a los cuales estoy de acuerdo, la oficina del Comisionado de
Agricultura puede tomar una acción de cumplimiento contra mí por la violación de las condiciones de este
permiso de material restringido.
Yo he leído y entendido estos requerimientos y estoy de acuerdo en cumplirlos.
Iniciales aquí
Operador de la
Propiedad a evacuar:
Nombre en letra de imprenta
Firma
Fecha
Teléfono:
7/11/2014
Una copia de esta notificación deberá ser proporcionada al operador / ocupante de la concesión de permisos de propiedad.
Enviar una copia firmada a la provincia con su plan de trabajo.
Number on Map/Notification Log:
Methyl Bromide OUTER BUFFER ZONE Encroachment Agreement
Outer buffer zones must not contain residences or onsite employee housing that may be occupied while the
outer buffer zone is in effect. No outer buffer zone shall extend into properties that contain difficult to
evacuate sites or other similar sites identified by the commissioner.
I give my permission to
\
Fumigating Permittee
Monterey County RM Permit No.
to extend the buffer zone of the proposed chloropicrin fumigation onto my property.
I understand that the fumigating permittee will notify me, at least 48 hours before the fumigation, of
the specific date and time of the start of the fumigation; which areas of my property are affected and
the date & time of the anticipated expiration of the buffer zone.
I will be responsible to make sure that no one is allowed in the buffer zone which is on my property except
to transit; perform cultural activities relating to the production of an agricultural commodity; perform
general residential chores and yard work; or the following activities: _______________________
______________________________________________________________________________
I understand and will inform my employees that if at any time while the tarps are on the field sensory
irritation is observed by any person in the vicinity my employees must evacuate the area.
4. I will notify any employees who are working on my property that a buffer zone has been
established on the property, and I will inform them of the specific date and time of the start of the
fumigation; the anticipated expiration of the buffer zone; symptoms of sensory irritation; and steps
to take if anyone experiences symptoms of sensory irritation. This includes my employees,
employees of licensed pest control businesses, and employees of farm labor contractors
whether hired by me or by a packer, shipper, processor, or broker to harvest crops on my
property.
5. I will provide this notice before the employees begin work activity on the property where a buffer
zone has been established.
6. I can notify employees of a Farm Labor Contractor (FLC) or Pest Control Business (PCB) by
giving written notice (containing the information in 1. above) to the FLC or PCB. I must inform
the FLC or PCB that they are required to give the notice to their employees.
I understand that if I fail to do the items to which I have agreed the Agricultural Commissioner’s
office may take an enforcement action against me for violation of the conditions of the fumigating
property operator’s restricted material permit. I certify that I received a copy of this
document for my records.
Property Operator
Granting Permission
Print Your Name
Ranch Name (if applicable)
Signature
Date
Address
Phone Number
7/11/2014
Fax Number
A copy of this notice must be provided to the operator/occupant of the property granting permission.
Submit a signed copy to the county with your work site plan.
Numero en el Mapa/Registro de Notificación:
Permiso Para Que Un AREA EXTERNA De Una Zona Restringida Se Extienda Dentro
De Una Propiedad Adyacente
Yo doy permiso a
Empresa o persona quien fumigará la propiedad de la persona que tiene el permiso
para extender el área EXTERIOR de la zona restringida dentro de mi propiedad, durante la fumigación
propuesta de Bromuro de Metilo.
Yo entiendo que la persona que tenga el permiso de fumigación me notificará, por lo menos 48 horas
antes de la fumigación, de la fecha y hora especificada en que la fumigación empiece, así como también
de la fecha de expiración de la zona restringida; qué áreas de mi propiedad se vean afectadas y la fecha y
hora de vencimiento anticipado de la zona restringida.
Seré responsable de asegurarme de que nadie está autorizado en la zona restringida, que es de mi
propiedad, excepto para el tránsito; realizar actividades culturales relacionadas con la producción de un
producto agrícola; realizar tareas residenciales generales y trabajar en el jardín; o las siguientes
actividades: ________________________________________________________________________
Entiendo y le informaré a mis empleados que si en algún momento, mientras que el plástico esté en el
campo, la irritación sensorial es observada por cualquier persona en la vecindad, mis empleados deben
evacuar el área.
4. Notificaré a cualquier empleado que está trabajando en mi propiedad que una zona de protección se
ha establecido en la propiedad, y les informaré de la fecha y hora especificada del inicio de la
fumigación; del vencimiento anticipado de la zona restringida; síntomas de irritación sensorial; y los
pasos a seguir si alguien experimenta síntomas de irritación sensorial. Esto incluye mis empleados,
los empleados de las empresas de control de plagas con licencia, y los empleados de los
contratistas de mano de obra agrícola si contratado por mí o por un empacador transportador,
procesador, o cualquier otra persona/ compañía que levante la cosecha en mi propiedad.
5. Voy a ofrecer este aviso antes de que los empleados comiencen la actividad laboral en la propiedad
donde se ha establecido una zona de protección.
6. Puedo notificar a los empleados de un Contratista de Trabajo Agrícola (FLC) o plagas de negocio de
control (PCB), notificando por escrito (que contiene la información de 1. Anterior) a la FLC o PCB.
Debo informar a la FLC o PCB que están obligados a dar aviso a sus empleados.
Yo entiendo que si yo fallo en realizar los puntos anteriores acordados, el Comisionado de
Agricultura puede tomar una acción de cumplimiento en contra mía. Certifico que he recibido
una copia de este documento para mis archivos.
Operador de la Propiedad
Que otorga el Permiso:
Nombre en letra de imprenta
Firma
Localización:
7/11/2014
Nombre de Rancho (si procede)
Fecha
Teléfono:
Fax:
Una copia de esta notificación deberá ser proporcionada al operador / ocupante de la concesión de permisos de propiedad. Enviar una
copia firmada a la provincia con su plan de trabajo.
Number on Map/Notification Log:
Residential Encroachment / Vacating Agreement
for Methyl Bromide Outer Buffer Zone
I give my permission to
\
Fumigating Permittee
Monterey County RM Permit No.
to extend the outer buffer zone of the proposed methyl bromide fumigation at
Location of property to be fumigated
onto my property.
I agree to move out of my residence during the time of the fumigation so that the outer buffer zone can extend
into the area where my house is located.
I understand that I must be out of my residence for
hours.
I understand that the fumigating permittee will notify me at least 48 hours before the fumigation, of the
specific date and time of the start of the fumigation, which areas of my property are affected and the date and
time of the anticipated expiration of the buffer zone.
I understand that during the time I agree to be out of my house I may only return to my residence for:
in order to perform general residential chores; yard work; feed animals; or the following
(Length of time)
activities:
.
I understand that if I fail to do the items to which I have agreed, the Agricultural Commissioner’s
office may take an enforcement action against me for violation of the conditions of this restricted
material permit.
I have read and understand these requirements, and agree to comply with them.
Vacating
Property Operator:
Print Name
Signature
Date
Phone Number:
7/11/2014
A copy of this notice must be provided to the operator/occupant of the property granting permission. Submit a signed copy to the county
with your work site plan.
Número en el Mapa/Registro de Notificación:
Residencial / Acuerdo para Extender la Zona Restringida de Bromuro de
Metilo y Desocupar la Propiedad
Doy mi permiso a
/
Empresa o persona autorizada para fumigar
Núm. De su permiso de materiales restringidos
Del Condado de Monterey
Para extender la zona restringida de la fumigación de bromuro de metilo propuesta en
Dirección de la propiedad a la cual se
en mi propiedad.
fumigara
Estoy de acuerdo en salir de mi residencia durante el tiempo de la fumigación de manera que la zona
restringida externa puede penetrar en la zona donde se encuentra mi casa.
Yo entiendo que tengo que estar fuera de mi residencia durante
horas.
Entiendo que el autorizado para fumigar me notificará por lo menos 48 horas antes de la fumigación, la
fecha y la hora especificada de inicio de la fumigación, que se ven afectadas las áreas de mi propiedad y
la fecha y hora de vencimiento anticipado de la zona restringida.
Entiendo que durante el tiempo Estoy de acuerdo en estar fuera de mi casa y sólo puedo volver a mi residencia
para:
con el fin de realizar las tareas residenciales generales; trabajar en el jardín; alimentar a los
tiempo (hora)
siguiente animales; o las siguientes actividades:
.
Entiendo que si no cumplo con los artículos a los cuales estoy de acuerdo, la oficina del Comisionado de
Agricultura puede tomar una acción de cumplimiento contra mí por la violación de las condiciones de
este permiso de material restringido.
Yo he leído y entendido estos requerimientos y estoy de acuerdo en cumplirlos.
Iniciales aquí
Operador de la
Propiedad a evacuar:
Nombre en letra de imprenta
Firma
Fecha
Teléfono:
7/11/2014
Una copia de esta notificación deberá ser proporcionada al operador / ocupante de la concesión de permisos de propiedad.
Enviar una copia firmada a la provincia con su plan de trabajo.
Number on Map/Notification Log:_______
Date of Delivery: _____________________
NOTICE TO VACATE PER VACATING AGREEMENT
(A copy of this notice must be presented to the operator/occupant of the property to be vacated at least
48 hours prior to the start of the fumigation.)
Thank you for agreeing to move out of your residence during the fumigation of my property, so the
buffer zone could extend into the area where your residence is located.
This is to notify you that you will need to move out of your property on:
am
Date
Time
pm
Circle one
We anticipate that you will be able to move back into your residence on:
am
Date
Time
pm
Circle one
Please sign below to acknowledge that your have read and understand the vacating requirements and
agree to comply with them.
Vacating
Property Operator
Print Name
Signature
Date
Fumigating
Property Operator
Print Name
24 Hour Contact Phone Number
Fumigating property operator must keep a signed copy for your records and submit a signed
copy with your NOI.
7/11/2014
Number on Map/Notification Log:_______
Date of Delivery: _____________________
NOTIFICACION PARA EVACUAR LA PROPIEDAD ASI COMO
FUE ACORDADO
(Esta noticia deberá ser presentada al operador o a la persona que esté viviendo y ocupando la
propiedad que va a ser evacuada al menos 48 horas antes del comienzo de la fumigación.)
Yo estoy de acuerdo en dejar mi residencia durante el tiempo de la fumigación para que la zona
restringida externa pueda extenderse hasta el área donde mi casa está localizada. Entiendo que deberé
estar fuera de mi residencia por un período de 48 horas. Yo también entiendo que deberé evacuar mi
residencia el día:
am
Fecha
Hora
pm
circule el tiempo apropiado
Usted puede regresar a su residencia por un período de tiempo de
No. de horas
Para poder llevar a cabo la siguiente actividad:
.
Leí y comprendo estos requisitos y estoy de acuerdo en cumplir con ellos.
Firme en la parte indicada para comprovar que si a leido y entiende los requisites de acuerdo con las
condiciones de evacuar su residencia.
Persona que
evacuará la
propiedad
Nombre en letra molde
Firma
Empresa o persona
cual llevara acabo
la fumigacion
Fecha
Nombre en letra molde
Número de Teléfono del Dueño
Compañía mantenga una copia firmada para sus archivos y presentar una copia firmada con su
NOI.
7/11/2014

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