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TMsAm has been approw+d by the Cobrodo M►ned Land RedanmWaa Board p&wsaont to hs <br /> aat%=*Y andler the Caleredo Lent Reclamation ArtfiW the Exlnaatfan of CanstFusamn hWer:ials <br /> and the Colowda Uk"Land Redmation Act far Nerd 8"k MetA aad pitsiyrwtad M 419 <br /> Operegans. Any alternation or modif eatlon of this form shall result in <br /> Applicant: Hall-Irwin Aggregates,LLC By: <br /> D 2017 Bret H Manager <br /> �� <br /> NOTARY FOR PERMIT APPLICANT <br /> STATE OF COLORADO } <br /> } <br /> COUNTY OF WELD j <br /> tore me th4Y 7,by Bret Hall as <br /> Egnpgt � tes, .the Applicant. <br /> Stets of+Co1ae� o' <br /> Notary 10 a 19964021059 <br /> o • <br /> Notary Public <br /> My Commission expires: <br /> SIGNATURE OF URUUNRE OWNER <br /> Structure Owner:WELD COUNTY Signatu &k <br /> Date: July 10, 2017 Title: Julie A. Cozad, C , Board of <br /> Weld County Commissioners <br /> NOTARY FOR STRi,1MRF,Q I�ff,[R <br /> STATE OF COLORADO } <br /> } <br /> COUNTY OF WELD } <br /> The foregoing was acknowledged before me this 10thday of July ,2017,by <br /> Julie A. Cozad as Chair of <br /> CHERYL LYNN NOFFMAN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20144048044 <br /> }"aWMMISSION EXPIRES DEC. 19, 2018 N ry P Ic <br /> My mm ssion expires: ryl ynn of fman <br />