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38 <br /> seq.18.F.Peowdoh—fll3 tnattaol 6ccosacs c!1'cctivc b5 indx:rtrJbelow <br /> r❑If thk contract becomes effective on the date HLM signs the cuntract.DLRI will check this box. <br /> ❑If ihlm corstractbecnmri effective only after certain con ditioni ire mel,BLM will check this bus,list the cenditionm below,and litdkatelbe <br /> effective date. <br /> See.$9,Appeof-You may appeal any decision that U LM makes in regard io this contract under Parts 4 and]M40 of l[tin 43 of the Cod c of Federal <br /> Regulations. <br /> -lire liZowing Geoids havo executed this conlean as of <br /> PURC11Aal;R I HE UNfiydl STATF,S OF AMEIRWA <br /> .3ohn Gilleland,Cd,l Gravel Products <br /> 13y Greene I.;ferneat80rr <br /> (individual or Flom Fiance} (Print Nm no*f BI.M Official) <br /> 2MI Howay 160.Durango,00 fit 301 <br /> (Address) [$ignatu RI.M Offidall <br /> (970)38"1 12 t iold Manager,Tres Rl*s Field 011ie s <br /> -include area ) [Fitic} <br /> •�� � - ��.•ADZ <br /> (5 iart a1 urel <br /> Ifyou area corporation.WiN carparaicseal here <br /> "I itk I I•JS.tti I001,makca it a crLrm for any pc sm knnm _0 or wMilillyis nuke tumydepare"Iortgsncy ofthe United Slant any fats,tSe outtorftwolent <br /> s1dmnc*or MjWmadaiiorts es to my n191ler within as stfQW b it fine afup m$I01000 and ialprku mini up to 5 years, <br /> W NOTICES <br /> The Privacy Act of 1974 and the regutation in 43 Cf R 2.49(d)provide that you be furnished the foItoN ing ill fonation in connWioa with infortnulc n <br /> mquko by clot application <br /> AUTHORrfft 30 U-SX.bpi ct scq.;43 CFR Group 3600 <br /> PR ENC1FAi.PURPOSE:BLM uses[his inforrhffilomt to idcmify the Parties entering inla contracts for disposing of mineral atalcrials. <br /> ROUT1 NE USF.S:131.M will transfer information front the record or the regard itself to appnayriate Foderak Slatc,1omf,or foreign agencies,wb n <br /> rcievatu to crkn Inal,civil,w Kgulalory invesltgalions or prosatatlorts_ <br /> EFFECT OF NOT PROVIDING INFORMAT11ONz If you do nm provide this information to HLM,we will nest be able to process your application far <br /> a eatt=L <br /> Tire Paperwork Redw0J"Act requires u%to inform you that: <br /> The RLM is c*lgoting this information to process your tt TIka0an and effect a binding contract- <br /> The ULM will use this information to identify and communicate with applicants. <br /> You taus4 respond to this roquest to gel a benefit. <br /> You do not have to rrWotid to this or any other PHeral agency_spsnsond information collection unless it displays a valid OM11 control number. <br /> BURDEN HOURS STATE MCNT" Public reporting burden for this roan is estimated to average about I hour per response,tne]uding the time for <br /> rovkwing irrsAttaiof+s,ge teeing and maintaining data,and co"o ing and reviewing the farm.You may submit comments regard Ing the burden estimate <br /> or ray Aher aspect of ills fa m 16t U.S.Dvpertment of the lntcrior,lltvcau of Land hhinagcment(1004-01n3l 1lurcau In£om ation Cnitc Aion Clcarance <br /> Officer(WO-M),1949 C Strcct,N.W.,Roam 21341,M,Wo.Ehingtori,R.C.W240 <br /> I Form 3600-9.pogo 3) <br />