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a <br />Identification <br />t Inspector's Initials ~___ <br />~~C~Ie~C;,~° ( <br />~~ <br />6~ I ~ f `' Grower's Initials <br />Field Number. <br />COLORADO DEPARTMENT OF AGRICULTURE Date ~;~~~ <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 />P~EA'tE PRINT IN INK <br />Grower ~ Address/box Number 5S/j' ~ ~~ 9 /V <br />CityJ; __State~~Zip Code f//a~ PhoneJ/9_ 7SS~-379 <br />County of Origin aT1,~~~in~ <br />This is to certify that`tl'fe 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 Colorado Weed Free Forage Crop Certification <br />Act 3: •27.5 <br />/ ,03~ HAS <br />/'~ check one) ^ HAS NOT <br />'fie f' ~teria contains those guidelines. <br />s- . i 6el~ /es ez o3 _ <br />i itir of Insp or Inspector Name ( ease Print) Inspec ion Date <br />IdBntif)~ Forage Crop Type Oaf~S•tYclur' <br />Acres Inspected, e~ Acres Certified ~ Cutting Date ~-3~ -a3 _ <br />Amount Harvested from Certified Acres ~ ~ L O Bales <br />Bale Size (check one) /: ^ large round ^ large square <br />5 5 ~ small 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. Thia ceRiflcate shall be Issued only upon final verification of date of curiing and amount <br />of for:~~ge harvested, prg_vlded to the Department of Agriculture by the grower. <br />Inspector <br />DPI-wp-ns oumomlon: <br />p{NO WhM~ • Gnaq~r Plnk • DPI Gran - In~p~dor <br />