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M l 0t W?0 ,7 a - <br />Application Checklist <br />9 Application Form: Complete the form located on page 5. <br />1E Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br />and Safety. <br />1Z Performance Warranty: Complete the form located on page 11. <br />19 Financial Warranty: Submit the appropriate Financial Warranties or conditional <br />replacement Financial Warranties using the forms posted on the Division's website <br />(available online at http://mining:state.co.us/Mineral%2OFonils.htm). <br />Cd Demonstration of Legal Right to Enter: Identify the owners of all surface and mineral <br />rights, obtain the documentation described above, and submit to the Division. <br />131-M -GMC 28`t042- capf &HAGif 01 <br />❑ Structure Agreements: Obtain new Structure Agreements if Permittee had been required <br />to do so. NO 7RUCIU F -S LEE No Z Pi1'CER <br />RECEIVED <br />SEP 14 2015 <br />Division of Reclamation, <br />Mining & Safety <br />-4- <br />