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12/01/2003 14:20 9706410954 VALCO INC <br />PAGE 03 <br />COMMERCIAL APPLICATORS ARE LICENSED BY THE COLOF.ADO DEPARTMENT OF AGF It"ULTURE <br />„ B~RRy <br />Customs lOiltro/ <br />N Irvin StrCCI <br />Cunnixun, Co. N12311 <br />Phune:1971q bit-339N <br />Address 1~ C [~~>>><_~_ _ <br />City, Statclip (=-~Ln(N t ~~1~. ~ c:.ei <br />5' z~ U <br />Project Location ~r a ='I'L ~, Site_t~WWvl~t~. Datcj~_ <br />'1'ime~'' 'I - I1: ~ LI- l~arget L~~~ j 'tS'tl-6 Weather (-'rr,[ f~. ~~hF'' _ t °'~TS l h~ <br />~~S i ' ~ t~S y~, C.,L <br />Name +l? ~ '7 1.L' PA #Cv7?I~i ~I l Dilution Rate. ~ I ' (LYx' C~'-,r.tc'a da. -:Stt_k21> <br />Application Rate _ Amount used =". fot , S S~ I 'harge~,7) e~. <br />`,tu z. <br />Namr <br />Name <br />Name <br />EPA q <br />Application Rale <br />EPA ~ <br />Application Rate <br />_ F.PA tt <br />Application Rate <br />M,QygjQ.;~/pQy~~ttt cost t <br /> <br />Dilution Ratc <br />Amount used <br />rill <br />Dilution Katc <br />Amowtt used (al <br />Dilution Ralr <br />Amount used !Q> <br />~~r~ <br />I`harge <br />I'harge <br />(:barge <br />t~c• <br />!'.'harge~ <br />! ,r _ miles (k1 .~~ I `barge t Nt <br />.~ ~2 ;~Minutesrl~ t `barge ~7~ `_ <br />'' ~ 4p <br />~Ottt) ~~--"- <br />('ommcnts. ~~.llTtl _~..2.~6~E C. ~ lt'..~:~ Ir~.~;..--~--~-1~:~1~1 .... <br />\C'k'.ti(tN'LIf I ri i 11h:1'I': Italoasr of Liahiluv and xaxynmae ++f die work +xda:md Cttaniulx u+ hu acad. "1 vnluntxnl~ panwypxte m me.wwa, ral»Cdad undaalnnding and <br />uaattnmg Ih: known anA unnmiaipapd rake ~1 dgravtn aaexTt htt myecll'. andvv anv,orQ+Lrvnu , thu lilll risk nlaoriulyd wnh Nr dtrnnal• In he apt h rd uU+rdwixe I would <br />.#u~+cvu~x to nu'ive U+e 4r~iUe nyuepad" "1 hurcv+ aruaifiu'+tIY 4al,xve'thu llt mtexl ~\liPlia:d++m ('cmy+any and d~ anq+L.vw. In+m ;uta aar..ryd.mi uhi+t+ is my due to w,wmirc <br />nrxlixmt aa, willlid nr wxna+n mixuivuWA or mtmlitmal wrung dmng'. <br />P s1'\II~ V'I' 1'nl~ x ~~hs arede arrnngemaiu arc maG. lh. amount due is payaM1le wl+vl ..7a'iecv~re rmdaaM. In the awvu .d'n~v+~aa+» un. the a, gamer ngrs~x io ~xv liv all <br />r+at~ ~+f rnll.wiuo, mciuding ras+Mnahl¢ ytmmw'.u 18ev. <br />Customer J.Barry <br />Signature: Date: Signature: _ <br />(Pre work) (Pre work) _ <br />Customer J.Barry ~ . ' ~. ~ j;L'4r'~v ~ ~~ <br />Signature: Date: ~ Signature:' .L 1~7Gt_ <br />(post work) Laost rk) <br />