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FREMONT COUNTY WEED MANAGEMENT <br /> 201 N.6th Street,Room 118 <br /> Callon City,CO 81212 <br /> (719)276-7317 <br /> Nick.bankston@fremontco.com <br /> Landowner Name:_D�Amn% r B f, .cJt- C- <br /> 0, <br /> Landowner Address: CI A r i,mo, - Y-1 6 C 9, G9 . Cancn G h� <br /> Date of Application: j /(l 1 9 <br /> Site of Application: C CA nr ox"A AL e-Fr I C <br /> Pesticide(s) Applied: J5c-o moL ra <br /> Amount Applied: 3 0 Z. <br /> Re-Entry Interval*: <br /> Grazing Interval*: h a mo' c ► 4 1 0 cs <br /> Crop Rotation Interval*: I-A moc�h <br /> Precautionary Statements*: W IA <br /> *=information that is found on label if provided <br /> Notes: <br />