PERMFILE122596

• Permit No: M2004025
• IBM Index Class Name: Permit File
• Doc Date: 4/13/2004
• Doc Name: 110c Appl.
• From: Oldcastle SW Group Inc. dba Four Corners Materials
• To: DMG
• Media Type: D
• Archive: No

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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 cxmditions:
1. All necessary approvals from local government have been applied for (Section 34-32.5-110(I)(a)(vrii).
2. To the best of my ]mowledge, all significant, valuable and permanentman-made structure(s) in existence at the time
this application is filed, and lacatod within 200 feet of the proposed affected area have been identified in this application
(Section 34-32.5-115(4)(e), C.RS.). (NOTE: For 110 operations, the affected area includes all lands delineated by the
permit boundary.)
3. No mining operation will be located on lands where such operations are prohibited bylaw (Section 34-32.5-115 (4)(fj,
C.RS.).
4. As the applicant/operator, I do not have any mining/prospecting operations in the State of Colorado currently in
viohrtion of the pmvisions of the Colorado Land Rer]amati~ Act for the Extraction of Construction Materials (Section 34-
32.5-120, C.RS.).
5. I understand that status 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. 1984.
Signed and dated this J ~ s t , day of ~~~ C""~-~rvZCU ~ ~{-
lam' ~., om-r~ ~--~--~--~ ~l ~'°- ~Ot"~If Corporation Attest (Seal) -~ . ~ :_ J_ -
Applicant/C+perator U =
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Signed: ~C~~ ~ ~ ~~~.J~
Title: ~~,a~flzrvs-CSC / o t3~id..rteliJ
Signed/~ ~ L
Corporate S - or Equivalent
TownlCity/County Clerk
State of Colorado )
SS.
County of Mesa )
The foregoing inatn,.nent was aClmowledged before me this 31 s t
day of March 2004 , by
a5 Resource Manaeer Of United Comvanies of Mesa County

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Notary public
My Commission expires: 3 / 29 / 07
"~' SIGNATURES MUST BE IN BLUE INK
Mlmmleharclv~"~s\CCO~ntQim110 (10/15/7W 1)