2009-10-16_PERMIT FILE - M2009082 ‎(26)‎

• Permit No: M2009082
• IBM Index Class Name: PERMIT FILE
• Doc Date: 10/16/2009
• Doc Name: Ex. S- Perm. Man-made Structures w/i 200'
• From: Lafarge West, Inc.
• To: DRMS
• Media Type: D
• Archive: No

The parties hereto acknowledge and agree to the above-stated items.
AGREED:
Lafarge West, Inc.
By: Date:
Eric R. Reckentine
Area Manager Northern Colorado Aggregate Division
State of Colorado )
) ss.
County of )
The foregoing instrument was acknowledged before me this day of
, 20_____, by Eric R. Reckentine as Area Manager Northern Colorado
Aggregate Division of Lafarge West, Inc.
My Commission Expires:
Notary Public
Structure Owner
Structure Owner Signature
Date:
State of Colorado )
) ss.
County of )
as
The foregoing instrument was acknowledged before me this
20_____, by
of
My Commission Expires:
Notary Public
R41137_0291Doemne=%Adjr_m SUucft=XSUUaurc 0w Agreeme=\Chl 96..:" Ag=.&C
Page 2 of 2
Agreement to Mine Within 200 Feet of Permanent Manmade Structures
Lafarge West, Inc./Dana Christiansen
day of