2013-01-28_REPORT - M1981158

• Permit No: M1981158
• IBM Index Class Name: REPORT
• Doc Date: 1/28/2013
• Doc Name: Annual Report
• From: Forest Lakes Metropolitan District
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: KAP
• Media Type: D
• Archive: No

Labor
PHONE: [phone]
FAX: 8 66 - 270 -0183
Customer Name:
Address
- i-
Location of Application:
Target Pest:
Comments
2,4 -D Amine
Milestone
Redeem
Other
Surfactant
Dye
Dilution Rate
App. Rate
Cost/oz./pt./qt.
.Z �`7 /cS X 1;25
COSTS:
V012
Chemicals:
.v aia fit.
178
JNTY ROAD 133
..VEL, COLORADO 81329
6/_s,244L 741
Total Cost
111 Mfg=
11111111:
f
g'3
Invoice No. 2134
Date e lG / 1-/
Commercial Applicator licensed by the
Colorado Department of Agriculture
License #06567
NM License # 55937
Utah License # 4001 -17077
'77, 83
TOTAL DUE 1an
Due on receipt. 10% monthly on balance after 30 day