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i <br />,/ <br />~~~~iU~'~~ L( <br />Identltication <br />Inspector's Initials ~____ <br />Grower's Initials j~ <br />COLORADO DEPARTMENT OF AGRICULTURE <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 />Field Number,~~, <br />Date ~ 03 <br />Certified According to the Regional Weed Free Forage Standards <br />PLEA;iE PRINT IN INK <br />City~;~~ <br />Counts of Orig <br />This i; to certifir <br />Legal c 13scription <br />Act 3° •27.5 <br />jcheck <br />e E! ~teria <br />~;~~/_. <br />igx3lur of In <br />egal I) cripl <br />~' Forage <br />Address/t3ox Number SS~j' ~ ~ ~~ 9 N <br />Zip Code ~~/a S•- Phone 7/9- 7Sf~-37,~~ <br />Ihat`tffe forage crop, owned by the aforementioned grower and grown on the land identified in the <br />below, has been officially inspected pursuant to the Colorado Weed Free Forage Crop Certification <br />one) <br />Crop <br />,!§C HAS <br />^ HAS NOT <br />Iineryyi those guidelines. <br />~L.~6el~~.l/.r ~ 03 _ <br />Inspector Name ( ease Print) Inspec ion Date <br />Acres Inspecteti e~ Acres Certified ~ Cutting Date ~ -~~ -~~ <br />Amount Harvested from Certified Acres ~ ~ L O Bales <br />Bale ~ ize (check one) ,/: ^ large round ^ large square <br />5 5 7 ~~ small square ^ other <br />NOTIC 1=: This inspection is valid if the forage crop described herein is cut within ten (10) days from the date <br />of this documelnt. This certificate shall be Issued only upon final verification of date of cutting and amount <br />of for:~~ge harvested, urovided to the Deaartment of Agriculture by the Grower. <br />Inspec:or <br />oPl-wF-os omnemlon: <br />W/DO WhN. - Gror.r Plnk • DPI Gran - In. p.dor <br />