2018-06-18_REVISION - M1991035 ‎(3)‎

• Permit No: M1991035
• IBM Index Class Name: Revision
• Doc Date: 6/18/2018
• Doc Name: Request For Succession Of Operator
• From: Lafarge West
• To: DRMS
• Type & Sequence: SO4
• Email Name: ECS
• Email Name: MAC
• Media Type: D
• Archive: No

-2 -
This form has been approved by the Mined Land Reclamation Board pursuant to sections 34-32-119, C R.S., of the
Mined Land Reclamation Act and 34-32.5-119, C.R.S., of the Colorado Land Reclamation Act far the Extraction of
Construction Materials Any alteration or modification of this form shall result in voiding any permit issued on the
altered or modifhed form and subject the operator to cease and desist orders and civil penaltiesfor operating without a
permit pursuant to sections 34-32-113, C.R.S, of the Mined Land Reclamation Act and 34-32.5-113, C.R.S., of floe
Colorado Land Reclamation Act for the Extraction of Construction Materials.
Applicant and Successor hereby request the State to consent to the assignment of the approved Permit Application
to recognize the Successor as the approved Applicant under the permitting process.
Lafarge West, Inc
Name of Permit Applica
BVr
Signature of Officer
General Manager
Title of Officer
Aggregate Industries Management, Inc
Name of Successor Appli t—
-7;
— _
By
Signature of Officer
General Manager
Title of Officer
NOTARY FOR PERMIT APPLICANT
STATE OF CO ktXrad, 0
) ss.
COUNTY OF Le- a r S LsC, 1
The foregoing instrument was acknowledged before me this Ll '�' day of 2Lt..Y\ , Q QI , by
Cor\CUA as t'' 0. Y of
1 4_n2 f ►, jt4. 1rnC r
SARAH GREM �1
BLIC
STATE� p NOTARY PUBLIC
NOTARY ID 2017400TT57
µY COMMISSION EMPIRES FEBRUARY 21.2W My Commission expires: a + 112 1
NOTARY FOR SUCCESSOR APPLICANT
STATE OFV
"���
COUNTY OF ��.r�' tX> ss.)
The foregoing instrument was acknowledged before me this Lf t4\ day of Jt -)C)/'?, by
as of fpa'1.19
ZZA
Lf
SARAN GREGA NOTARY PUBIC NOTARY PUBLIC
STATE OF COLORADO
WARY 10201T400M My Commission expires: Q L, t
W COMMISSION EVRES F®Rt1AFtY2t 2VI