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12!01/2003 14:20 9706410954 <br />VALCO INC <br />PAGE 02 <br />COMMERCIAL APPLICATORS ARE LICENSED HY TF~ COLORADO DEPARTMENT OF AGRIC JLTURE <br />f~BARRy Customer~/~IC~C~ ---- <br />CL6t0 !O/Pub7/ Address <br />City, State Zip < r r ~ (n ~ 41~: t~ <br />8 Irwin ycrcct ~ I Z3U <br />Gunnison. Co. 812311 <br />Phony: (9711) Gd I J398 <br />' [~~/ <br />~Iq~A <br />~L_S <br />Date ~ ~' :t <br />' <br />\~ ...IZ )^~ <br />f~ ~ ( ' <br />. <br />21-r''t <br />Site,`-n.`'~ <br />' <br />~ <br />~ <br />Project Location <br />cr2l ~ <br />~ <br />--- <br />Weather ( <br />et \ ~l7 "~( ~-- <br />Tar <br />' <br />g <br />S - <br />Time <br />j~rbicide~ <br />EPA 21 9'- .~ <br />Name~ll_l~r~ ~~ ''- <br />Dilution Rate ~iCrn `• ~' <br />~ ~ ~ Charge / /l' <br />Amount used ~`~ = ~?~~.~-- <br />Application hate <br />Name EPA # Dilution Rate <br />Amount used (a~ ('barge <br />Application Rate <br />Name EPA ~ Dilution Rate <br />1'Itar <br />e <br />Application Rate g <br />Amount used (a) <br />Name EPA ~ Dilution Rate <br />Application Rate Amount used (a1 I;harge <br /> <br />A~juvants~/(1 <br />=Fk^~itry'Z~~ cjz C~ S-n I,har a ~Y' <br />t~ (~ ^ g ~.--- <br />j <br /> <br />Move j„q and move t-ttt coat ~.. ~,a. <br />/Z miles (w7~7~_1=barge ~ '- <br />Mitti gan Rlicationcost ~' <br />~: <br />/ ~fky Z:~ Minutes(a~~ 1'Iharge %S ,~ <br /> c~ c <br />Tonal ~_---"~ <br />'+. 1) c ~' ~ <br />Comments: 11i ~' ~ I[ '{1:i~ (r~l~ 1._~~~._ ~ (t7F~. ~:~,_/.~~)---- <br />\C'I:ti(IU'I,h;IH~AII;~'1': k.deaFl: ofliabilily and arza~rtanrs:nl'thework orda:md C'h~niullF lu he,n~ '1 rn4mtarilr palti~7pau: in the.Ixsiov ngocxlad undeyandingand <br />a.a~pting the known and w+anliapaWd risks Ia®M.oln aca+{A Ym myxell:and'or any'ernplnya,the full riak aFFlwiatud wlU+Ule 3l miuel~to he apt liad. IAllzrwiw:l would <br />+ilonvc mu to ruative Utc srs~iae rlyuctod". "I hWevl aV~ifieally'rWeaFC dlC C'I1U111Ve1 .'~r111W111m C'VInpMV 2nd IlF rn,phrv4~ Ilmn an V atY}d'UI{ MIIIVtI IF nQ dYL IV anV~(kICY <br />negligun au, willful ur wMUm miFamdura to yrt2rllirnal wrongdoing' <br />P:\1' S4(ti l' 1 inla}s oUw+uodir amngum~nts are madr. lhr amoum duc+s pnyahlc w'hpt.w-n•iwr erc rutdaud. In nc~ c.~ml nl'ncm•pn)*n.g11. Utt u aum+a Fgea to pay li+r all <br />caFF ol'w,llwilm. nlcludmg reaFinahlc auWnry^s fans. <br />Customer <br />Signature• <br />(pre work) <br />Customer <br />Signature: <br />(post work) <br />J.Barry <br />Date: Signature: _ <br />(Pre work) ~~t~ ,~ <br />J.Barry <br />Date: ~j' L~ Signature: _ ti ~. <br />~.. <br />post wor <br />