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Gravel <br /> Check One Water <br /> Soil t] <br /> Other (� <br /> i <br /> PURCHASE ORDER NUMBER <br /> E1 Paso County <br /> DEPARTMENT OF PUBLIC WORKS <br /> ��3170 //Century, Colo. Spgs. , Colo. 80907 <br /> !ller Dated 1 19 X0 _ <br /> dress @Iay Refer to the above number or <br /> provide a copy of this order <br /> r 1 ri otl�3} with any claim you may find <br /> i necessary to file. <br /> declare that I am owner of the real property wherein <br /> ists and is located in Township // (s) , Range W, <br /> =tion /� , Quarter / The Deoartment of <br /> olic Works may purchase from me, in the quantity <br /> :imated below, during the period ���1 21 . /f PU to include <br /> 6'71 Sr1 subject to the folio niw g Special Provisions: <br /> none this will be so noted hereon) . <br /> e <br /> .t of Approx. No. Cost <br /> sure of Units Per Unit <br /> /o d <br /> rents to be made monthly by Warrants issued by El Paso County based upon <br /> number of units purchased during prior month. <br /> ignature of Se er) <br /> !hase Order Acquired byIle <br /> Signature <br /> Tit lt�lr <br /> WY �— <br /> (Purchasing Agent) <br /> zase Order Approved by <br /> Max L: Ro hschild, P.E. <br /> Director of Public Works/County Engineer <br />