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RECEIVED <br /> OCT 10 Z016 <br /> Application Checklist DI�MiN0N oFRECtAU4 <br /> SAND SAF��N <br /> 'Application Form: Complete the form located on page 5. <br /> l/Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br /> Zd Safety. <br /> rformance Warranty: Complete the form located on page 11. <br /> V �0 Financial Warranty: Submit the appropriate Financial Warranties or conditional <br /> t�3 C replacement Financial Warranties using the forms posted on the Division's website <br /> (available online at http://mining.state.co.us/Mineral%20Forms.htm). <br /> l � E] 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 new Structure Agreements if Permittee had been required <br /> to do so. <br /> S001 <br /> << 12- <br /> M-2017-027 S001 <br /> Complied! No Violations! <br /> 0 Minor Infractions SJM/whe <br /> I <br /> -4- <br />