Laserfiche WebLink
-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 ant , <br /> BY ,_ 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 �nk UL YA D ) <br /> ss. <br /> COUNTY OF fS ur ) <br /> The foregoing instrument was acknowledged before me this y+4-\- day of-Tct- .P Q Q1 �S ,by <br /> as On of <br /> d <br /> SARAN GREGA <br /> NOTARY PUBLIC NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20174007757 <br /> MY C'-)MMISSION EXPIRES FEBRUARY 21,2021 My Commission expires: l <br /> 1 NOTARY FOR SUCCESSOR APPLICANT <br /> STATE OF CD\-DV-O Q ) <br /> ) ss. <br /> COUNTY OF Q r S C-YN ) <br /> The foregoing instrument was acknowledged before me this 9'�k day of , -DO[ ,by <br /> as of S <br /> SARAH GREGA <br /> NOTARY PUBUC NOTARY PUBLIC <br /> STATE OF GOLORAD <br /> 140TARY V 2J174UJ7757 M Commission expires: c} <br /> MY CC MMI'SSION EXPIRES FEBRUARY 21,2 21 Y P <br />