2015-01-13_INSPECTION - M1985040

• Permit No: M1985040
• IBM Index Class Name: Inspection
• Doc Date: 1/13/2015
• Doc Name: Insp. Rpt.
• From: DRMS
• To: Seifert Construction
• Inspection Date: 12/2/2014
• Email Name: TOD
• Email Name: TAK
• Media Type: D
• Archive: No

-6-
NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT
STATE OF )
) ss.
COUNTY OF )
The foregoing instrument was acknowledged before me this day of
by as of
NOTARY PUBLIC
My Commission expires:
APPROVED:
State of Colorado
Mined Land Reclamation Board
Division of Reclamation,Mining and Safety
By: DATE:
Division Director
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REVISED 02/01/2003