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1 <br /> CEIJ (Yj 1 q 4f (l 0 lr <br /> Application Checklist <br /> ® Application Form: Complete the form located on page 5. <br /> ® Application Fee: Include check payable to Colorado Division of Reclamation, Mining <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://mining,state.co.us/Mineral%20Fonns.htin). <br /> Ad-I-*4&&16 Atw-hors <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 /> /A/* 7 � Structure Agreements: Obtain new Structure Agreements if Permittee had been required <br /> to do so. <br /> kL�i <br /> RECEIVED <br /> I I� <br /> MAY 0 a 2017 <br /> Division of Reclamation, <br /> Mining&Safety <br /> - 4 - <br />