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:
Date:
A Ar
State of Colorado
} ss.
County- of
l T e fore?oing instrument was acknowledged before -ne this ' day of
20 a c7 , by-E rv4?-D eck-en i Ax r Northam Colorado
-&,%r-e,gate-Div-igorl-of Lafarge West, Inc. ? h v l j ? ` l ?? ??^? { r1(?11 Cti kf '
MyCo'mmission Expires:
Notary Public
BARBARA BRUNK
NOTARY PUBLIC
STATE OF COLORADO
My Commission Exoires IQj1M2012
-Structure Owner"
BLUE CHIP OIL, INC.
By,
Structure Owner S nature

State of Colorado, }
} ss.,
Countyof Lrr(rvjol' )
Fh
The foregoing.instzument'was acknowle ed before me this / day of
(1?tin-?i 200% ,by y k ?
as O«l,A of Blue Ch' ,Oil, Inc..
My Commission Expires: la_uc.- 5 ao/
Notary Public
LORI KING
Notary Public
State of Colorado
My commission expires Aug. 5, 2012
Page 2 of 2
Agreement to Mine Within 200 Feet of Permanent Manmade Structures
Lafarge West; lneJBhze Chip Oil, Inc.