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<br />O.C. A'2 Cod Mans -Permit No. C-80-002 <br />n~ M Prior Experienctr <br />9 r Project Name IV MR.DGC PAIaF Dateisj X99 i - PR.E.9ENT <br />Project <br />Contact N3ma <br />Brief bescription of Project (include jpcation and size) <br />i (ol <br />Te <br />~~e <br />PhOrie_, Q~ 79s c~~~Q <br />~Q ~ IMi~ <br />ry A~af~,.s <br />TAE Sires is <br />Ss TT{A+~ N~ ~~ <br /> <br />®r Project <br />Project Owner ~1~ - <br />Contact Name <br />Brief Description of Project jinclude location <br />rF~~~ <br />70 9N5 H95$ <br />RO!}D ~1{51~t <br />Pea.c~R~ $ tray <br />TArt>~ S[OIAE S ua t 'TArUN6 OdF~ 1000 t~S a~~~~ <br />T +- u~ ~ ,ergs, T/1~ ~'~ fb~-r C'~ui~>>=~/~-~ernl~ <br />c..o~wA-QE ~ Ac.~a4~nat! Fo~eTir~l~~erars,, <br />-nfs mnri~ac. is Lie/N6 uses 0y dr+t6 ro CoNr ~ cvoRK, l AcsD .G+o L~fA/t[-~j <br />The undersigned agrees to comply with a l Rules and Regulations of th Colorado Surface Coal Mining <br />Reclamation Act, the General Conditions of the Purchase Order and the Rurchase Order Terms and ~`NOkALOG/C' <br />Conditions and all other requirements of these documents: ~` Ibl~$ OF <br />Individual or Company Name Tll~ .SU7>`y <br />Professional Cert'rfication <br />_ „~ <br />Date <br />Phone <br />Pp. 1 of 1 P~p~ <br />P-~ us,N6 <br />19s ~~ <br />~4S A~YD <br />RECEIVED T~ `S~'p/f2 <br />AUG 3 0 1995 /-l~t,~c~.QA/Eirra.- <br />Division of Min r I ~~ ~M <br />e a s,~ GepIoBY <br />2: <br />