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proposed affected area described within Exhibit A of the Reclamation Permit Application for <br /> Firestien Resource, File Number: M1996060. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to <br /> its authority under the Colorado Land Reclamation Act for the Extraction of Construction <br /> Materials and the Colorado Mined Land Reclamation Act for Hard Rock, Metal,and <br /> Designated Mining Operations. Any alternation or modification of this form shall result in <br /> voiding this form. <br /> Applicant: Hall-Irwin Aggregates, LLC By: <br /> Bret Hall, Manager <br /> Date: (12 --7 , 2017 <br /> NOTARY FOR PERMIT APPLICANT <br /> STATE OF COLORADO ) <br /> COUNTY OF WELD ) <br /> The foregoing was acknowledged before me this+ t day 2017, by Bret Hall as <br /> rWikA gates, L C,the Applicant. <br /> Notary PublIC <br /> State of Colorado <br /> M �otary ID#19964021059 <br /> ,�Qssion Expires 12-05-2020 Notary Public <br /> y ommission expires: <br /> SIGNATURE OF STRUCTURE OWNER <br /> Structure Owner: WHITNEY DITCH Signature: <br /> Date: (�j >I I Title: /a e!{ �` <br /> NOTARY FOR STRUCTURE OWNER <br /> STATE OF COLORADO ) <br /> COUNTY OF WELD ) <br /> The foregoing was acknowledged before me this -:a3 day of )Ltl�, 2017, by <br /> ClnkA EVZ 1-t; as Wi;(� 'Ye C'-Ld v- of <br /> AMBER FRAI <br /> NOTARY PUBLIC <br /> STATE OF COLORADO D <br /> NOTARY ID 20174014104 <br /> MY COMMISEgNifXPIRES 3-31-2021 Notary Pubic <br /> My Commission expires: <br />