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RFr,FIVED <br />NOV 21 1995 <br />CERTIFICATON OF RECEIPT <br />Division of Minerals & Geology <br />Please complete both copies of this form and return the pink copy to Pete Lien & <br />Sons, Environmental, P.O. Box 767, Rapid City, SD, 57709-0767 in the envelope <br />provided. <br />I hereby certify that I received copy number 15 of 21 Revised of the "110 to <br />112 PERMIT CONVERSION APPLICATION" for "MUNROE GYPSUM <br />QUARRY, M-77-002HR, LARIMER COUNTY, COLORADO." <br />DATE RECEIVED ~ 2 ~~395 <br />N~L~e ~ti~ , <br />TIME RECEIVED ~n .?n ~ .tia . <br />PRINTED NAME OF <br />PERSON RECEIVING <br />COPY Mr. Harold R. Roth <br />SIGNATURE OF <br />PERSON RECEIVING <br />COPY <br />ORGANIZATION <br />REPRESENTED BY <br />PERSON <br />SEAL OR STAMP OF <br />ORGANIZATION, IF <br />USED <br />MNATH FARMS, INC. owner of MUNROE <br />RANCH <br />PO Box 217, Timnath CO 80547 <br />REMARKS AND Revised copy is bound in an orange cover and <br />COMMENTS should be merged with the material previously sent <br />in a green cover to make a complete copy of the <br />application package. <br />The Munroe Ranch is the surface land owner <br />of all land to be disturbed by this extraction <br />and of all land within 200 feet of all land to be <br />affected by this extraction, to the best of our <br />knowledge and belief. <br />