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STATE OF COLORADO <br /> PURCHASE REQUISITION <br /> SUGGESTED VENDOR AND ADDRESS PURCHASE SUGGESTED VENDOR AND ADDRESS PURCHASE <br /> ORDER NUMBER ORDER NUMBER <br /> Dirt-N-Iron <br /> 1417 326 Road VENDOR NUMBER VENDOR NUMBER <br /> Silt, CO zIP 81652 ZIP <br /> TERMS FOB TERMS FOB <br /> DOC ID CODE NO. <br /> PV DATE <br /> F ACCT PRD BUD FY ACT PV TYPE <br /> I I 1 1-1 22 ❑ ❑ <br /> FUND AGENCY ORG SUB-ORG APPR BS ACCT OBJECT SUB-OBJ REV SRC <br /> 2 7 0 P K I A I C C I C 8 m 1 0 8 2 3 1 1 1 <br /> SUB-REV PROGRAM GBL FUNCTION REPORTING CAT PROJ/JOB NO OFF REC ACCT <br /> MIN R Cjj_j <br /> BILL TO-Name and Address SHIP TO-Name and Address 1 <br /> Division of Minerals and Geology Designated Job Site it <br /> 1313 Sherman St. , Rm. 215 <br /> Denver, CO 80203 <br /> � - I <br /> i <br /> REQUESTING AGENCY-Name and Address TELEr HONE PERSON(S)TO CONTACT { <br /> 1Same as Bill To (303) <br /> 866-3567 Maggie Van Cleef I <br /> 1 hereby certify that t=, IYED <br /> nece ry f the uccessful operation FAX I <br /> of the agency and th mo t Ind�fund esignated is 1 <br /> sufficient to cover (303)ED SIGNATURE 832-8106 <br /> r.- nMmnDIT`/NI ANf1 UNIT <br /> ITEM A;rii^.iiNT <br /> 1 Nn QUA ITY UNIT CCIMPLFTF DESCRIPTION OF ITEM OR SERVICE COST <br /> ;EFERENCE PRICE AGREEMENT # <br /> L & L Energy/ Blue Flame Forfeiture Proj. <br /> ! Permit #C-81-053 <br /> i <br /> 1 Shrub Planting, 1993 ' <br /> 1 1 Job Plant 500 shrubs at the Blue Flame Coal N/A $2200.00 <br /> Revocation Site as specified in telephone <br /> bid by Paul Krabacher <br /> !I <br /> 1 <br /> REQUESTED DELIVERY DATE <br /> 395-53-05-2141 <br /> WHITE-Purchasing Copy YELLOW-Accounts&Control Copy PINK-Agency Copy GOLDENROD-Department Copy <br />