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Check One <br />PURCHASE ORDER <br />Eller r/P cc^~ <br />9dress 1 ~i1 <br />i <br />Dated <br />Gravel <br />Water <br />Soil [] <br />Other <br />NUMBER <br />G3/a / <br />%L19 0 " <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•~ner of the real rooerty wherein ~-it,t,,.•-! _ <br />Gists and is located in Township~_(s), Range .moo W, <br />action /,~ Quarter N ~ The Department of <br />iblic Works may purchase from me, in the Quantity <br />:timated below, during the period e c ~ / ~ to include <br />~c~~ ,. 1 / s~b ject to the , llo}'~ing Special Provisions. ,/ <br />f : ne this'wi 1 b ~, noted hereon) . d~~aco ..- .~~ ~. -~~ .~~~,2,/ ~r <br />.~ / - <br />y I ~ ~ /_.. A~,/el) SCI /IP..L"~•A Qf~'.~ i ..i 7~ ~w~t ,Z:. ~ e.z....._ L Uns~.~rl <br />it of <br />asure <br />~~ ~/~ <br />E1 Paso County <br />DEPARTMENT OF PUBLIC WORKS <br />3170 Century, Colo. Spgs., Colo. 80907 <br />~~a <br />Approx. No. <br />of Units <br /> <br />Cost <br />Per Unit <br />is <br />~~~ ~ <br />yments to be made monthly by Warrants issued by E1 Paso County based upon <br />e number of units purchased during prior month. <br />(Signatu of Seller) <br />-chase Order Approved by " '~'X <br />Max L. Rothschild, P.E. <br />Director of Fublic Works/County Engineer <br />