PERMFILE129402

• Permit No: M2007069
• IBM Index Class Name: Permit File
• Doc Date: 9/24/2007
• Doc Name: Reclamation permit application
• From: Centennial State Paving, Inc.
• To: DRMS
• Media Type: D
• Archive: No

-8-
Assn aodsuiadrepresentativeof~eapplioot, IhaebyoatifyduttheopQaliondescn'bodltssmet me e~qumregimpoa~d
of the bllor6tg tetttts and osoditiata:
L Tothe beat of ory lmoabdgq all sigoifir~nt, vakabk sad perrsoeat rnat-madc mss) m at dte dtne
tltis apprieation is filed, and betted vrtthot 200 featotthepnapaaadaffxtad ateahase hem in this appfaation
(Se~tim 3432.5-1 !S(4xc~ C.R.S.}
2. No mitrias operatim riff be toeaoed on bads wfiae atch opaatiotts tre prahbited by Iar
(SoetYOO 3432.5-t l5(4xt), C.R.S.;
3. Ae the applieaoilopaaoor, l do oot have tttryedeapbradon ~~~ m the State at'C.olarado cmemly m
violation of the provisiom of ~e Calaado Land Rrechraation Ad bar the F:naalian a£ Qorohncoion Mater
(Scctim 3432.5-120, C.R,S.) as detetmimd through a Head 5edbg.
4. I mdaesimd flat stacaaema in the appliatim are bdoa nrde tmdQ peodty of perjury aM that Echo statemarca
ma8e botein arc pama6able as s Cmsa ! miademeaoar ponaaast to Seetim t1i-S-503, C.RS.
ribjw.lm i.mr.~w.ty a1wARarf Lr~dJQseMaaats.lawdrvsrr arcaYar 3I,i25-i't2,GItS, alerts Cdw.Ia Lnr/
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'..r ward «Me.(bsir.r ra~idJarar sad a•6Jser a1e.r,rrr r mreal Iesht «r<vs d obr/rsallesJr yrrdg
Sigaed and dated des
CENTENNIAL STATE PAVIIJCi, INC.
orCorttpatyname S.
l~
JAMEB BARTME8t3
T{~ PRESIDENT
Staoe of COLORADO )
)~
Cpmtyaf PIIEBLO )
2007
_`
[fCorpaotian Attmt (Sfai)
5.;~.
CotpotateSxtetayor .
ToMtJCityK`.ouneyCletk
The foregoing i ras adatorledged befwe me this S r h ~, o{ Se o r ~ ~, g c-z 2007 ,
~ by JAMS BARTM$SS as PRESID$AT Of~S1R'P$NAIAT, STATE PAV[A(} IN(!
Notay PubTiC
My~; tc_ad'-e~
SIGNATURES MUST H$ IN BIi.U6 Q~IK
sis wire (Arpo.eassit irl005)