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Check One <br />PURCHASE ORDER <br />Gravel,[~~ <br />Water <br />Soil [] <br />Other (~ <br />NUMBER /oZf <br />E1 Paso County <br />DEPARTMENT OF PUBLIC WORKS <br />3170 Century, Colo. Spgs., Colo. 80907 <br />alley ~-wvt~C~~ ~.~.1.~!^c~-/ <br />~Ucr2%I- <br />~- 3v/- as-a~. <br />o~aaa 3 <br />Dated ~n /r~ 7 - 19 <br />Refer to the above number or <br />Provide a copy of this order <br />with any claim you may find <br />necessary to file. <br />declare that I am o'+~mer of the real property wherein ~ir.n-,rr~ <br />Gists and is located in Township /~ (s), Range /+. W, <br />action a. a, Quarter S ~V The Department of <br />iblic Works may purchase from me, in the quantity <br />;timated below, during the period /d- ~~7^'7Y to include <br />/c ./7- c'z/ subject to the following Special Provisions: <br />~f npne this will be so noted hereon). Slch~ •x~-~~ G,Gra~/ 4.'/ , G...~...~H ~ <br />./ ~ ~n f e <br />pit of <br />~asure <br />Approx. No. <br />of Units <br /> <br />yments to be made monthly by warrant <br />~e number of unite purchased during p <br />rchase Order Acquired by, <br />Cost <br />Per Unit <br />~~ <br />lam"" " <br />s issued by E1 Paso County based upon <br />rior month. <br />•~ ~ ~'J7 <br />• ~~, <br />(Signature of Se ley) <br />Signature <br />Title <br />(Purchasing Agent) <br />rchase Order Approved by //~•~ .-~1~~-~,~.C<~~ <br />Max~L. Rottis hild, P,E. <br />Director of Public Worke/County Engineer <br /> <br />