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Identification <br />Inspector's Initials ~,- <br />Grower's Initials ,~_ <br />"~-•'"~ Field Number mst~ <br />\~ COLORADO DEPARTMENT OF AGRICULTURE Date ~Y~T <br />b`b 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 />PLE/iBE PRINT IN INK <br />Growth <br />City_;~ <br />County of <br />Address/Box Number~$Y~ ~ _~d 9 ~% <br />Zip Code ~//a,5~ Phone,7/q_ 7Sf~--~7~~ <br />This i:; to certify that~tffe forage crop, owned by the aforementioned grower and grown on the land identified in the <br />legal rbsscription below, has been officially inspected pursuant to the Colorado Weed Free Forage Crop Certification <br />Act 3; ••27.5 <br />d ~ HAS <br />c one) ^ HAS NOT <br />to containe those guidelines. <br />~ ,~.~a6e,~l a~//es ~z o3 <br />Insp or Inspector Name ( ease Print) Inspec ion Date <br />on /V/// ~ i3 /fin _ ?E <br />IdBntifj" Forage Crop Type D~f,S?Ya-i.~f- <br />Acres nspected ~ Acres Certified ~ Cutting pate ~-~0 -03 <br />Amour r Harvested from Certified Acres t-{ $ L 0 Bales <br />Bale Size (check one) J: ^ large round ^ large square <br />~3. 7 ~ small square ^ other <br />NOTICE: This inspection is valid if the forage crop described herein is cut within ten (10) days from the date <br />of this document. This certificate shall tre Issued only upon final verification of date of cutting and amount <br />of fora: ne harvested- provided to the Deaartment_of A~Iture by the grower. <br />Inspec <br />-PI-WF-05 Distrlbuilon: <br />M/00 Whlt+ - 6row+r Plnk • DPI Grnn - In+p+ctor <br />