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4 •J <br />).. • ~ <br />The Owner hereby warrants that he has good'title to t~ above described pre- , <br />miles; that he has [hc lawful right to grant this Option, and that he agrees to <br />i hold the Department harmless from any and all claims from others asserting any <br />interest in the subject land, i <br />Additional Canditioas See Attached <br />White /Rive/r~Ag,/gr~egates, Int. <br />DEPARTMENT OF HIGHi7AYS, STATE OF COLORADO ~t~.~~~'' '~~ <br />- (Ocmer(s) - Insert as appears <br />' above)) <br />District hateria s engineer <br />Bv: -. By: _ <br />DISTRIBUTION: .. _. .':'.t _ _ .: ..__ ' . . <br />Original - Design Engineer ' <br />1 - Owner or each Owner <br />1 - Materials Engineer - Denver <br />~... .. .. <br />2 - Construction Engineer - District '% - <br />1 - Maintenance Engineer for all State Fortes Projects <br />1 - District Materials Engineer - - <br />!r * * * * ~k * * * is <br />STATE OF ) j ~ ., . _ _, ., . <br />SS .._ . _...,_ ~. - <br />_ _ - <br />COUNTY OF ) ~ ,.....-. -, <br />~~ ~ The foregoing instrument was acknowledged before me this day of <br />, A.D. 19 , by <br />Witness my hand and official seal. ~ - ' <br />.~ My commission expires <br />(SEAL) '~ ~ ~ ~ Notary Public <br />(Original to be acknowledged and recorded if, !.n the opinion of the District <br />Engineer, there is possibility of transfer of [he premises or question of title. <br />Refer to D.O.H. Pfemo No. 418, dated April 7, 1972.) <br />Please attach plat of pit area. . <br />Field Sample No. <br />Page 2 <br />G <br />