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( aoa? D°/ <br />% application Checklist <br />I Application Form: Complete the foil located on page 5. <br />"Application Fee: Include check payable to Colorado Division of Reclamation. Minn_ <br />and Safety. <br />Performance Warranty: Complete the form located on page 11. <br />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: mininiz.stare.co.us`_Nlintiral°c_OFonns.htm). <br />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 />Structure Agreements' Obtain uew Stnictttre Agreements if Permittee had been required <br />\ to do so. <br />i <br />{'-•-.r: ,+!ED <br />TIN 0._ fl <br />�"it 10!1 <br />�,y <br />