2010-01-21_PERMIT FILE - M2009094 ‎(2)‎

• Permit No: M2009094
• IBM Index Class Name: PERMIT FILE
• Doc Date: 1/21/2010
• Doc Name: Notices
• From: DRMS
• To: Various
• Email Name: RCO
• Media Type: D
• Archive: No

-8-
Certification:
As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum
requirements of the following terms and conditions:
1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time
this application is filed, and located within 200 feet of the proposed affected area have been identified in this application
(Section 34-32.5-115(4)(e), CILS.).
2. No mining operation will be located on lands where such operations are prohibited by law
(Section 34-32.5-115(4)(f), C.R.S.;
3. As the applicant/operator, I do not have any extraction/exploration operations in the State of Colorado currently in
violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials
(Section 34-32.5-120, C.R.S.) as determined through a Board fording.
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.
This form has been approved by the Mined Land Reclamatiton Board pursuant to section 34-315-112,CRS, of the Colorado Land
Reclamation Actfor the Extraction of Construction Materials. Any alteration or rnodgiicadon of this form shall result In voiding any
permit issued on the altered or modti led form and subject the operator to cease and desist orders and civil penalties WE
without a permit pursuant to section 34-315-123, CRS
r #4@r: f
Signed and dated this I -? day oft -'0- e M' b e-r Z
ASOha- 5iTu - Zr5 ,_Enc.
App icant/Operator or Company Name
Signed: :Z
Title: President
State of 03 `bade
ss.
County of 4?ft N M ' 1
Town/City/County Clerk
The foreg-otin-g instrument was acknowledg . before me this n day of C ?xn h
by 6A C Y Q as Q'C 2S\C? !nk - of Sd?ft?fi-? (11151 C?7 Sn r .
My Commission expires: t
SIGNATURES MUST BE IN BLUE INK
You must post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a
if Corporation

Signed: r i FE, 7, .mow
Cor njomduy or Equivalent