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• <br /> PRC1CUR'EMENT REQUEST TO:(Procurement Office) 1.REQUESTING OFFICE <br /> INSTRUCTIONS:Agencies must provide Leadville Ranger District <br /> entries in unshaded areas. 2015 N. Poplar Street <br /> See reverse. Leadville, Co 80461 <br /> 2 3 4 5, 6 7 8 9 1A.PROCUREMENT REQUEST NO, <br /> RECEIVING CONTRACT ORDER UNIT FUND PURCHASE/DELIVERY <br /> OFFICE NO. NUMBER DATE CODE CODE ORDER NUMBER SUB• -� w <br /> '•.. - ' `y <br /> e <br /> 9/6/2001 ..> ..-.< : Y ;..... .. <br /> CHECK ONE 10.TO: (Seller) :,...a`:,:'dt $. ifr.IO,'_ (Can g- nrFisrestnra&on) � .NI <br /> N <br /> ❑ Purchase State of Colorado -4 <br /> Order Division of Minerals &Geology _ ITEM TO BE REMOVE-DA FRQfS[I_N�kx1ONAI�•FOREST <br /> 1313 Sherman Street, Room 215 SYSTEM LANDS.- `..2 <br /> ~ = --.- - •-.. <br /> ❑ Delivery Denver, Colorado 80203 <br /> 12 Or- r 13 ❑ INSIDE DELIVERY RirQUESTED <br /> 15 16 18 <br /> 14 <br /> LINE ACT. DESCRIPTION BUDGET ACC. 17 UNIT 19 • 20 <br /> ITEM CODE OBJECT LINE QUANTITY ISSUE UNIT PRICE AMOUNT <br /> 1 Removal of remaWp of heavy equipment from 1 total 1,250.00 1,250.00 <br /> National Forest. Remains are located just off of <br /> Lost Canyon Road. Removal to take place - <br /> between June - July 2002. _ .. • <br /> Job Code MGGL20C to fund removal costs. - <br /> Division of Minerals &Geology contact: <br /> Mr. Jim McArdle <br /> (303)866-3789 <br /> For addilonal Information,Please contact: <br /> Linda S. Fox 719-486-0749 <br /> TECHNICAL CONTACT TELEPHONE NO. <br /> 21 FOB POINT 22 DISCOUNT TERMS - <br /> 25 <br /> Sub-Total ► $1,250.0 <br /> 23 REQUIRED DELIVERY 23A NEGOTIATED DELIVERY 24 SHIP VIA 26 ESTIMATED FREIGHT 27 <br /> (Dos not <br /> use ASAP) 7/31/2002 N/A TOTAL ► $1,250.0 <br /> 28 29 ACCOUNTING CLASSIFICATION <br /> ACC. q B 30 31 <br /> LINE 5 10 5 C 3 4D 1 4 E• 1 2 DISTRIBUTION AMOUNT <br /> 1 MGGL20C - 100% <br /> RECOMMENDED SOURCE(S) (If necessary,use attachment) I certify that he above items are necessary for use in the public service. <br /> TITLE -- <br /> i q•—k; ' - 14"--7.--ILg'.--- <br /> . SIGNATIJR • • REPRESE ... r 77---- <br /> '•>. ----a <br /> 7 AD-700(4/82) <br />