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-2- <br /> This form has been approved by the Mined Land Reclamation Board pursuant to sections 34-32-119, C.R.S., of the <br /> Mined Land Reclamation Act and 34-32.5-119, C.R.S., of the Colorado Land Reclamation Act for the Extraction of <br /> Construction Materials. Any alteration or modification of this form shall result in voiding any permit issued on the <br /> altered or modified form and subject the operator to cease and desist orders and civil penalties for operating without a <br /> permit pursuant to sections 34-32-123, C.R.S., of the Mined Land Reclamation Act and 34-32.5-123, C.R.S., of the <br /> Colorado Land Reclamation Act for the Extraction of Construction Materials. <br /> Applicant and Successor hereby request the State to consent to the assignment of the approved Permit Application <br /> to recognize the Successor as the approved Applicant under the permitting process. <br /> Lafarge West, Inc Aggregate Industries Management, Inc <br /> Name of Permit Applicant—,- Name of Successor Applicant <br /> By ( B., — - <br /> Signature of Officer Signature of Officer <br /> General Manager General Manager <br /> Title of Officer Title of Officer <br /> NOTARY FOR PERMIT APPLICANT <br /> STATE OF Cc!u--')Cac� O ) <br /> T ) ss. <br /> COUNTY OF °L ar S"---N ) <br /> The foregoing instrument was acknowledged before me this Ll day of SLk-VNA ,a OI t by <br /> as of <br /> SARAH GREGA � <br /> NOTARY PUBLIC <br /> STATE OF COLORADO NOTARY PUBLIC <br /> NOTARY t0 201740OT757 <br /> MY COMMISSION EXPIRES FEBRUARY 21,2021 <br /> My Commission expires: a 1 <br /> NOTARY FOR SUCCESSOR APPLICANT <br /> STATE OF CQW--t-Ct&L) ) <br /> ss. <br /> COUNTY OF It <br /> The foregoing instrument was acknowledged before me this H f4\ day of a OI'? ,by <br /> as offQ��_�P f;ES�Yi aS <br /> SARAH GREGA <br /> NOTARY PUBLIC <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20174007757 My Commission expires: [ <br /> MY COMMISSION EXPIRES FEBRUARY 21,2021 <br />