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State of Hawaii <br />ISLAND OFFICE ADDRESS: <br />Ii,E L&-�,Kc,r-J �4, -W.. <br />DEPARTMENT OF AGRICULTURE <br />cu-� <br />Plant Industry Division90- <br />Pesticides BranchNOTICE <br />OF PESTICIDE <br />USE/MISUSE INSPECTION <br />OAT <br />HOUR <br />____ <br />A <br />PM <br />NAME OF INDIVIDUAL <br />1 i,h aU1 C P ( c r- <br />e- Pi�2wn._i( <br />TITLE -- <br />r<wtC�l L�re� <br />NAME (Firm, Farmer, Homeowner, etc.) <br />ADDRESS (Number, Street, City, State and ZIP code) <br />_1,,P�� <br />F�� <br />as C --tit-<< s, <br />Cr ><.,�r��,/w' .ti .( <br />(��,-� I,a f Cry,?7 O <br />SIG,NAT7REI OF STATE INSPECTOR I _ TITLE <br />Cl �� Je <br />l�+l.' :n n Gi 1� Z- V (� >"r'1 � <br />_--� <br />REASONf OR INSPECTION <br />For the purpose of inspecting sites where pesticides are being used to collect data on the use of pesticides and to detemtinc <br />�. <br />whether pesticides are being used in compliance with the Hawaii Pesticides Law (Chapter 149A, HRS) and Administrative Rules, <br />Chapter 66, Pesticides, of the Department of Agriculture. <br />Ll For the purpose of inspecting sites where pesticides have been used and to determine whether the pesticides were used in torr. <br />pliance with the Hawaii Pesticides Law (Chapter 149A, HRS) and Administrative Rules, Chapter 66, Pesticides, of the Department <br />of Agriculture. <br />VIOLATION SUSPECTED: <br />L cf- (C a n c'-j� <br />J <br />i� <br />i <br />I <br />� � <br />I <br />1 <br />L — -- CONSENT — —------— <br />—� <br />❑ Voluntary Consent Necessary to Enter for Inspection and/or Sampling. j17J- <br />f � <br />The undersigned hereby voluntarily consents to an inspection of �'' i [�lL�q-;,-I �1.� 5��.-: L�_;; I`,, :D <br />of which I am Owner, Agent or Person -In -Charge, for the purposes of gathering information and/or samples'in connection with <br />the administration and enforcement of the Hawaii Pesticides Law (Chapter 149A, HRS) and Administrative Rules, Chapter 66, <br />Pesticides, of the Department of Agriculture. <br />--- <br />Ip SIGNATURE <br />, <br />TITLE <br />'— <br />DATE <br />F.,, P-33 - DISTRIBUTION: Original — DOA Record COPY <br />(R.I. 10/84) 2 — Owner/Agent Copy <br />3 — Inspector's Copy <br />