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This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority <br /> under the Colorado Land Reclamation Act for the Extraction of Construction Materials and the <br /> Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations.Any <br /> alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant: Colorado Milling Company, LLC, Representative Name: Mark A. Steen <br /> Date N Title: Agent LA-7 <br /> STATE OFCOLORADO ) <br /> ) ss. <br /> COUNTY OF BOULDER ) <br /> The foregoing was acknowledged before me this day of January 2019, by <br /> as Agent of the Colorado Milling Company, LLC . <br /> M Commission Expires: 6 t <br /> _ Y N <br /> Notary Public <br /> CEMRAN LAMICHHANE <br /> NOTARY PUSUC <br /> S7ATF OF COLORAOp <br /> NOTARY 10 20154019013 <br /> MYCOMMIS8p EXPIRES JUNE 29,2MO <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEGED BY: <br /> Structure Owner(s) Names) <br /> Date Title <br /> STATE OF COLORADO ) <br /> ss. <br /> COUNTY OF BOULDER ) <br /> The foregoing was acknowledged before me this day of 2019, by <br /> as of <br /> My Commission Expires: <br /> Notary Public <br />