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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 Successo Iieant —/- <br /> B By <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 hO OYOAU ) <br /> ss. <br /> COUNTY OF fS ur ) <br /> The foregoing instrument was acknowledged before me this y i-h day of-T(_—"\,t' Q01 �S ,by <br /> ��? e cy\U—f1 as .L .VY1 of <br /> SARAH GREGA <br /> NOTARY PUBLIC NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY IC,20174007751 <br /> MY C'-,MMISSION EXPIRES FEBRUARY 21,2021 My Commission expires: t <br /> NOTARY FOR SUCCESSOR APPLICANT <br /> STATE OF eD7� Ct�,Q ) <br /> ) ss. <br /> COUNTY OF 5C noCSc Y� ) <br /> The foregoing instrument was acknowledged before me this q�-k day of , Dd l k ,by <br /> Oka COY\CL+1 as r1'1 of <br /> SARAH GREGA <br /> L <br /> NOTARY PUBUC NOTARY PUBLIC <br /> STATE OF COLORPC <br /> 14OTARY If 20174OJ7757 M Commission ex Tres: d <br /> MY Cr.MMISSION EXPIRES FEBRUARY 21,2 21 Y p <br />