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I <br />`~ i <br />-~. ~ <br />1,. <br />I v ~l <br />~~~. ~ <br />Identlflcatlon <br />Inspector's Initials _ ~~ <br />Grower's Initials _ ~iC __ <br />Field Number <br />COLORADO DEPARTMENT OF AGRICULTURE Date o3 <br />DIVISION OF PLANT INDUSTRY <br />700 Kipling Street, Suite 4000 <br />Lakewood, Colorado 80215-8000 <br />(303) 239-4149 <br />CERTIFICATE OF INSPECTION <br />FOR WEED-FREE FORAGE CROP CERTIFICATION <br />Certified According to the Regional Weed Free Forage Standards <br />PLEA!iE PRINT IN INK <br />Grower ~ / AddressBox Number_J`S/9 ~ ~g/ 9N <br />City, ._State~_Zip Code ~//1S Phone Z/y_~9,P <br />;,ountr of Origin ,-~~~ <br />this is to certify tha'Yfhe forage crop, owned by the aforementioned grower and grown on the land identified in the <br />egal c inscription below, has been officially inspected pursuant to the Colorado Weed Free Forage Crop Certification <br />act 35.27.5 <br />,/ ~ HAS <br />(check one) ^ HAS NOT <br />Pst g~ c ' eria contains 'n those guidelines. L~/'~ //~/ ~,//~ <br />_EZ~ieya~GG~~i1~S ~ p.3 <br />gn r of Insp or Inspector Name (( lease Print) In a lion Date <br />al ~ sc ' 'on ~ ~? _ - ~ <br />fentif~ Forage Crop Type~,{(flrr~lz~~ <br />,cres nspected ~~~ ~ Acres Cert~ed ~~ Cutting Date $S -lO - t13 <br />amour t. Harvested from Certified Acres 5~ ~1'1~ Bales <br />ale Size (check one) ,/: ^ large round ^ large square <br />S'~r ~ - ~ small square ^ other . <br />IOTICI:: This inspection is valid if the forage crop described herein is cut within ten (10) days from the date <br />f this document. This eertlflcate shall be Issued only upon final verification of data of cutting and amount <br />f fort ge <br />Ispecux <br />OPLWFAS ~4dl6utlon: <br />