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EXHIBIT N Source of Legal Right to Enter) g g ) PAGE #1 Form 5510 -1 (August 2007) Name of applicant MOFFAT COUNTY FOAD DEPARTMENT Kind of material SAND AND GRAVEL Give legal land description RANGE 1 SECTION 1 TOWNSHIP 10N State of COLORADO 103W 10 SWSW Materials are to be used for RESURFACING COUNTY ROADS I HEREBY AGREE TO COMPLY WITH the special conditions as set forth below. I CERIIPY That the: (a) materials to be removed are to be used for the purpose noted above; (b) none of the materials removed are to be sold or bartered; (c) removal of materials can begin only upon receipt of an approved copy of this permit; and, (d) the Bureau of Land Management (BLM) must be notified upop completion of removal. I CERTIFY That I am a citizen of the United States, and of the age of majority in the State in which I reside. I FURTHER CERTIFY That the statements made by me in this application are true, complete, and correct to faith. onttnt ad on ;..ge 2) aJO 4z�v9 Date t� J i ,UJ9 I I (Date) UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT FREE USE APPLICATION AND PERMIT VEGETATIVE OR MINERAL MATERIAL APPLICATION nservatt. - 'ctices must be carried out as provided by 43 CFR 5511.1- 1(b),.2 -3(c), J .3 -3; tuipm.t:` r• t v. ' .prop :.: tints rft.,t be removed within ninety (90) Lys atter e..,,..ut.u,. J. to .3 CFR 5511.3 any use of the surface of the lands involved in this permit must not interfere with y min nr - :r r'. : ft 'Ile pr ovisie s of S °ction 4 of the Act of July 23,1955 U.S.0 0 APPLICANT PERMIT Address (include zip code) PO BOX 667 822 E. 1ST STREET CRAIG, CO 81626-0667 ( County of MOFFAT (� FIELD OFFICE 3LtI LIT S: =: r { FU ;� I (a . '- i,; _ .'•. r :; (' ' ri tauli APPROVED OMB NO. 1004.0001 2009 A(JG 2 imi }: March 31, 2010 2009 H COC73801 REFUGE #1 SUBDIVISION Expiration Date 09/21/2019 District LSFO I Estfr'ated q uantit y 50,000CY of my knowledge and lief and are made in good Title 18 U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction. SPECIAL CONDITIONS This permit is hereby issued for the materials applied for but may be canceled if it appears that this permit was issued erroneously or the terms or conditions contained herein are not observed. It will be subject to the following special conditions: SEE EXHIBIT A, SPECIAL STIPULATIONS The permittee must clean up all work areas and must remove or dispose of all refuse resulting from the permittee s operations; This permit is issued under the Act of July 31, 1947, as amended, and 43 U.S.C. and 1201, and under the free use privilege of the Act of May 14, 1898 (Alaska only). An annual report indicating the amount (cu. yds. or tons) of material removed must be filed with the District Office on the anniversary date of the permit, or within thirty (30) days after permit expiration (Alaska only). ( ignature of BLM)