PERMFILE125040

• Permit No: M1978143
• IBM Index Class Name: Permit File
• Doc Name: REGULAR OPERATION RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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4. I understand that statements 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.R.S.
Signed and dated this~~r~'( day of _, ~fl~.
Applicant/Operator If Co~ration At~t_d.Se~y~i)•
By: By: ~~ti~ ..-.z, s2.
Title: Corporate Secretary or Equivalent
Townr,~i.ty/County Clerk
.. .
State of )
55.
County of )
•
Tne foregoing instrument was acknowledged befo~•e me this _ day of
by as of
Notary Public
My Commission Expires:
2823E (02/05/93)
~'~ ~~~ -

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