Laserfiche WebLink
SIGNED, SEALED AND DATED this day of , <br /> Operator (SEAL) <br /> By: Du h»� <br /> Title: V l` Q,Oe« ;tS✓l�(' <br /> NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT <br /> STATE OF'("' <br /> \6:Y AS ) <br /> nn ) ss.: <br /> COUNTY Of <br /> r` ) <br /> he fore ing instrument was acknowledged before me this?S day of <br /> by as AP of <br /> 5 T FNPKAVY <br /> Y_CP???n1]SS1Qp Expires ,.; <br /> uj 2 <br /> Notary ID 1 2d03o0oo <br /> STATE OF COLORADO <br /> DEPARTMENT OF NATURAL RESOURCES <br /> MINED LAND RECLAMATION BOARD <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> By: \ - Date Executed: •f <br /> Division Director <br /> Rev.05/12 <br /> - 13 - <br />