REP42638

• Permit No: M1991079
• IBM Index Class Name: Report
• Doc Date: 4/19/1999
• Doc Name: ANNUAL REPORT
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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• ~ Inspector's Initials ~_
Grower's Initials -T err
' Field Number
COLORADO DEPARTMENT OF AGRICULTURE Date
DIVISION OF PLANT INDUSTRY
700 Kipling Street, Suite 4000
Lakewood, Colorado 80215-5894
(303) 239149
CERTIFICATE OF INSPECTION
FOR WEED-FREE FORAGE CROP CERTIFICATION
Certified According to the Regional Weed Free Forage Standards
PLEASE PRINT IN INK / !~
Growl ~ AddressBox Number g S
City: State t^ _Zip Code_~>/ ~~_Phone ~~^ $3 333;
County of Origin_
This is to certify that the forage crop, owned by the aforementioned grower and grown on the land identified in the
legal description tlelow, has been officially inspected pursuant to the Colorado Weed Free Forage Crop Certification
Act 35-27.5
,/ I~ICS
(check one;) ^ HAS NOT
m the criteria c;nta~ din those guidelines.
o
Ina ure of Inspector Inspector Na a (Please Print) I spe tion Date
Legal Description. S ~/ ~ ^oS ~ ~ ~~ S~'
Identify Forage Crop Type
Acres Inspeded_~~ Acres Certified Cutting Date ~ ' ~ t
Amount Harvested from Certified Acres ~ 5~ Bales
Bale Size (check one) ,/: ^ I rge round ^ large square
l~mall square ^ other
NOTICE: This inspection is valid if the forage crop described herein is cut within ten (10) days from the date
of this document. This certificate shall be issued only upon final verification of date of cutting and amount
of forage harvested, provided to the Department of Agriculture by the grower.
Inspector comments _ r.-'r'"~/1~T/~fttt C /~I~Q .fteT ~ S f-
DPbWF-a5 ObWbutlon:
07197 Whlte • Grower Plnk • UPI Green • In,pector