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r <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials <br /> and the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining <br /> Operations. Any alternation or modification of this form shall result in voiding this f�orrm. <br /> Applicant: Hall-Irwin Aggregates, LLC By: y% // <br /> Bret Hall, Manager <br /> Dat : , 2017 <br /> NOTARY FOR PERMIT APPLICANT <br /> STATE OF COLORADO <br /> COUNTY OF WELD <br /> The foregoing was acknowledged before me this(-5--'day o , 2017, by Bret Hall as <br /> Manager of Hall-Irwin Aggregates, LLC, the Applicant. <br /> DfMi14 M KRAFT Notary Public I <br /> My Com1irP0fires: <br /> State ot Colorado <br /> Notary ID#19964021059 <br /> My Commission Expires 12-05-2.020 IGNATURE OF STRUCTURE OWNER <br /> Structure Owner: PDC ENERGY INC Signature: <br /> Date: ( `��q° 1-1 Title: LCA-Aci T <br /> `RAdipe—A-A5g5ve_.- <br /> NOTARY FOR STRUCTURE OWNER <br /> STATE OF COLORADO <br /> COUNTY OF WELD <br /> The foregoing was acknowledged before me thia\ day of It, , 2017, by <br /> 'rct/vlvati .. ; �:1 (� as L ✓\zj�r�t x; ;�,of <br /> 7L 4-. �\�s, . <br /> 'v�L <br /> ike <br /> (seal) Notary Public <br /> My Commission expires: Wi, <br /> REBECCALJOHNSON <br /> NOTARY PUBLIC <br /> STATE Of COLORADO <br /> NOTARY ID 20174016200 <br /> MY COMMISSION EXPIRES APRIL 14,2021 <br />