PERMFILE106271

• Permit No: M2007009
• IBM Index Class Name: Permit File
• Doc Date: 2/5/2007
• Doc Name: 112c application
• From: The Denver Brick Company c/o Acme Brick
• To: DRMS
• Media Type: D
• Archive: No

8-
Certification
As an authonzed representative of the applicant, I hereby certify that the operation described has met the imnimum 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 nine
this applicabon is filed, and located within 200 feet ofthe proposed affected area have been identified m this applicaton
(Section 34-32.5-I 15(4xe), C.R.S.).
2. No mining operation well be located on lands where such operations are prohibited by law
(Section 34-32.5-115(4)(f), C.R.S,;
3. As the applicanUoperator, I donor have any extractionlexploration operations in the Staze of Colorado currently in
violation of the provisions of the Colorado Land Ralamation Act for the Extraction of Consnvcrion Matenals
(Section 34-32.5-] 20, C.R.S.) as determined through a Board finding.
4, f understand that statements in the application are being made under penalty of perjury and that false statements
made herein arc punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S.
ThB jorm has been approved bq the Mined Land Reclamation Board parsaaru to section 3442.5-171,C.RS, ojthe Colorado Land
Reclamation Acrfw the F.xhadlon ojConahacpon MateriaLc Aery alteraBon or madifTcatloa ajthisjorm shall result in
permit issued on the altered or modified jarm and subject the operator to cease and desist orders and ciuRPend jot operatjag
wirhoat a permit parsaaat to,seetlox 36-32.5-123, C.R.S ,t~ 'fir ' c KK--
r ~
Signed and dated this ~~ day of ~ 2007 ~~ CO (~ o rr~~ R ~9
The Denver Brick Company ~ rj~a~ ~
If Corporation Attest (Seal) /
ApplicanUOperator or Company Name
Signed:
Title:
Signed: ~Y~.CtA2fcl ~J mQ/~!"•(/rt,~/
Corporate Secretary o~ r Equivalea~
Stateof~~_(,~S )
) SS.
County of ~C y,,p.~,.,.~_ )
the foregoing insemmen1t\was acknowledged before me this _~~ day of _~y,L
2007,by_~~A ~. N~ni as (V~ ~of
~.I
Town/City/County Clerk
Christena D. Flann ~~~~~~~~~~~~
NQTARY PUBLIC otary Public
`~~,~ STATE OF TEXAS My Commission expires: ~ ~ ~~ /
MV COMM. DtP. 9~3a10 -"" ~"-"J
SIGNATURES MUST BF. IN BLl1E INK
N retire eli.rt,~imna Cuv~nmon I I] dac (Approved 05/11!2x105)