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Identlficatlon <br />`)~ ~, c- - • '~ ~` Inspector's Initials ~_._. <br />ll <br />i ~ ~ ,'t Grower's Initials ~' _____` <br />Field Numberf~~, <br />COLORADO DEPARTMENT OF AGRICULTURE Date „Z~ o~ _ <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 INIC <br />Grower Address/Box Number 5Sr`J' ~ ~~ 9 /V <br />City; State~~Zip Code ~//a S- Phone~9_ 7Sf~-37~ <br />Counti of Origin 2~ar~pJ <br />This i<. to certify thafttfe forage crop, owned by the aforementioned grower and grown on the land identified in the <br />legal c 13scription below, has been officially inspected pursuant to the Colarade Weed Free Forays Crop Cerlifiration <br />Act 3: • 27.5 <br />/ ,Q~ HAS <br />Jcheck one) ^ HAS NOT <br />e E' ~teria contains those guidelines. <br />p ~.~6e~~s) rez o3 --- <br />i tur of Ins or Ins actor Name ease Print Ins.ec ion Date <br />egal 10 crl ions r~ /~ /~_~7.E ___ `.__ _____ <br />I "Forage Crop Type Ga~~STYdur' ___ <br />Acres Inspected ~ Acres Certified. ~ Cutt+ng Date ~-~~ -~~ ___~ <br />Amount Harvested from Certified Acres ~l ~ (. 0 Bales <br />Bale °ize (check one) /: ^ large round ^ large square <br />5 5 7small square ^ other <br />NOTIC I=: This inspection is valid if the forage crop described herein is cut within ten (10) days from the date <br />of this document. Th(s certificate shall be Issued only upon final verification of date of cutting and amount <br />of fon~~~e harvested, erovided to the Deoartment of Agriculture by the strower. <br />Inspec <br />DPI-WF-OS Dl~trlbullan: <br />0{/00 WhMtt • Grow Plnk -DPI G~»n - In~p~dor <br />