REV100156

• Permit No: C1981008
• IBM Index Class Name: Revision
• Doc Date: 5/26/1993
• Doc Name: Unsigned Permit
• Type & Sequence: RN2
• Media Type: D
• Archive: No

5. The additional stipulations set forth in the attached rider,
if any, are incorporated herein by reference.
/XX/ a) Rider is attached.
/ / b) No rider is attached.
ACCEPTED AND AGREED:
By
Operator Title
STATE OF
COUNTY 0
DIVISION OF MINERALS AND GEOLOGY
COLORADO DEPARTMENT OF
NATURAL RESOURCES
Division Director
)ss
The foregoing instrument was acknowledged before me this day of
19_ by
as of
operator.
My Commission expires:
NOTARY PUBLIC
35a0G