2003-08-25_REVISION - M1992069

• Permit No: M1992069
• IBM Index Class Name: REVISION
• Doc Date: 8/25/2003
• Doc Name: TR Information
• From: Applegate Group, Inc.
• To: DMG
• Type & Sequence: TR5
• Email Name: JLE
• Media Type: D
• Archive: No

Affidavit of Material to be Imported
to the 83rd Joint Venture Site M1992069
THE UNDERSIGNED, states that to the best of his or her knowledge, the material to be
excavated as part of the City of Greeley stormwater channel construction and transported to the
83d Joint Venture Site (M1992069) for backfill, is clean and inert as defined in Rule 1.1 (20)
(Rules and Regulations of the Colorado Mined Land Reclamation Board).
William A. Sterling, P.E.
Public Works Director
City of Greeley