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<br />,, Project Name J~9N~1~/3CE <br />Project Owner /~L ~) <br />Contact Name A~ <br />Brief bescription of Project lin <br />-~9~ <br />Phone LO/'Y GONE <br />location and size) <br />Ti5lE ExrTaQE M/N~ <br />~t~ c~~(Fi9eE <br />g Project Name (.,OqL ~t7i <br />r <br />Project Owner P~rNSYW <br />Contact Name ~~' <br />Brief Description of Project 4include <br />F/ES/ 6N~d TIlE CXrI <br />ltiCtr/oiN6 '7~E <br />~E /!uNlN6 ~N1D <br />The undersigned agrees to comply with all Rules and Regulations of the Colorado Surface Coal Mining <br />Reclamation Act, the General Conditions of the Purchase Order nd the Purchase Order Terms and <br />Conditions and all other requirements of these documents: <br />Individual or Company Name <br />Professional Certrfication No. _ <br />Address ~ " <br />Phone <br />r.w t of t a.a. <br />O.C. ilt2 Cod Mine - Parnft No. C$0-002 <br />Prior Expaienta <br />_ 199a <br />Phone 601UE <br />and size) <br />RECEIVED <br />AUG 3 0 1995 <br />Division of Minerals t~ Geology <br />