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COMMERCIAL APPLICATORS ARE LICENSED BY INVOICE# Kn q <br /> THE COLORADO DEPARTMENT OF AGRICULTURE <br /> HARRYAKAJDOT Customer A <br /> &MOINWeeWCOWIVIInc. Address_ .0, <br /> 8 Irwin Street Gunnison,CO 81230 City,State ZippaL N)NTV , o1 > <br /> Phone: (970)641-3398 <br /> Project Location M( M15 Site 41, Date ii <br /> Time �V I r "'l 3Targ Weather ok- -C <br /> A <br /> Herbicides� II _ <br /> Name � ( IJV EPA A? 17Dilution Rate/ <br /> - <br /> 9 lr-- <br /> Application Rate r Amount used @ Charge <br /> Name EPA# Dilution Rate <br /> Application Rate Amount used @ Charge <br /> Name EPA# Dilution Rate <br /> Application Rate Amount used @ Charge <br /> Name EPA# Dilution Rate <br /> Application Rate Amount used @ Charge <br /> Surfactant/Dv Charge <br /> Mileage 1'�� miles @ /G Charge Jli <br /> Mixing and application cost Minutes@ �— Charge `' <br /> Comments: Total <br /> AN <br /> ACKNOWLEDGMENT: Release of Liability and acceptance of the work order and Chemicals to be used. "I voluntarily participate in the services re- <br /> quested understanding and accepting the known and unanticipated risks. I agree to accept for myself,and/or any employee,the full risk associated with <br /> the chemicals to be applied,otherwise I would choose not to receive the service requested." "I herein specifically'release'the Chemical Application <br /> Company and its employees from any accident which is not due to anyone's negligent act,willful or wanton misconduct or intentional wrong doing". <br /> PAYMENT: Unless other credit arrangements are made,the amount due is payable when services are rendered. In the event of non-payment,the cus- <br /> tomer agrees to pay for all costs of collection,including reasonable attorney's fees. <br /> Customer J.Barry ���/ /1J � <br /> Signature: Date: Signature: <br /> (pre-work) (pre-work) <br /> Customer w <br /> J.Barry <br /> Signature: Date: Signature: <br /> (post work) ( os work) o' <br />