2002-04-24_REVISION - M1978283

• Permit No: M1978283
• IBM Index Class Name: Revision
• Doc Date: 4/24/2002
• Doc Name: Conversion Application
• From: Walsenburg Sand & Gravel Inc.
• To: DMG
• Type & Sequence: CN1
• Media Type: D
• Archive: No

~-
Certification:
As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements
of the following terms and conditions:
1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this
application is filed, and located within 200 feet of the proposed affected area have been identified in this application
(Section 34-32.5-11~(4)(e), C.RSJ.
2. No mining operation will be located on lands where such operations aze prohibited by law (Section 34-32.5-1 li(4)(fl,
C.RS.;
3. As the applicandoperator, I do not have any extraction exploration operations in the State of Colorado currently in
violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Constmetion Materials (Section
34-32.5-120, C.RS J as determined through a Boazd fording.
4. I rmderstand that statements in the application are being made under penalty of perjury and that false statements made
herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS.
Signed and dated this ~ day of /_~=KYC[/C~ ~i ~ ~ ~-;
Walsenburg Sand & Gravel, Inc.
Applicantl0perator or Company Name
Signed~`-'""LcrQ~ G-~~
Louis P. Vezzani
Title: President
State of Colorado )
ss
County of Huerfano )
,'~, z
r •,
. ~p~ i• , ~.j;.
w ' .'~:
' ~:
~ttest(Seal) cJr:
`/~ ~ ~ ~d..~.
Signed: (/ ~
Corporate Secretary or Equivaleu
Town/City/County Clerk
The foregoing instrument was acknowledged before me this /57~ day of It~2 ~~ ~~ -~
by Lnu~S .~ (JL-zz,4.~/i as ~rnt;ge..~7r of lt~hLsEUpuxii ~tuDkCiR~ie~ TtiC
,~' p,..
~~~J .. •••h~~ L~-, ~'~
•
~~`
r~ ~ ~41 ~
='n • ~ ~, .~:,
S
7,T• :
,
: No Public
et
.•r
-
`• ~ ~ ~ ~ .~ ~ ' My Commission expires:
•.~q4q• , ,r~,t` r
' ""' SIGNATURES MUST BE IN BLUE INK
M:~mm\shuebsforrm~2823C012APP (071)7!2000)