2017-05-09_REVISION - M1997058 ‎(3)‎

• Permit No: M1997058
• IBM Index Class Name: REVISION
• Doc Date: 5/9/2017
• Doc Name: Application
• From: Bestway Concrete Co. / Hall-Irwin
• To: DRMS
• Type & Sequence: SO3
• Email Name: ECS
• Email Name: WHE
• Email Name: BJC
• Media Type: D
• Archive: No

This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its
authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials
and the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining
Operations. Any alternation or modification of this form shall result in voiding this form.
Applicant: Hall-Irwin Aggregates, LLC By:
Bret Hall, Manager
Date: , 2017
NOTARY FOR PERMIT APPLICANT
STATE OF COLORADO )
COUNTY OF WELD )
The foregoing was acknowledged before me this day of 2017, by Bret Hall as
Manager of Hall-Irwin Aggregates, LLC, the Applicant.
(seal) Notary Public
My Commission expires:
SIGNATURE OF STRUCTURE OWNER
I n
Structure Owner: PDC Energy Inc. Signature:
Date: Title: - 1 Ca-� �
NOTARY FOR STRUCTURE OWNER
STATE OF COLORADO )
)
COUNTY OF WELD )
The foregoing was acknowledged before me this day of ,2017, by
as of
(seal) Notary Public
My Commission expires: