Laserfiche WebLink
- 2 - <br /> This form has been approved by the Mined Land Reclamation Board pursuant to sections 34-32-119, C.R.S., <br /> of the Mined Land Reclamation Act and 34-32.5-119, C.R.S., of the Colorado Land Reclamation Act for the <br /> Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding any <br /> permit issued on the altered or modified form and subject the operator to cease and desist orders and civil <br /> penalties for operating without a permit pursuant to sections 34-32-123, C.R.S., of the Mined Land <br /> Reclamation Act and 34-32.5-123, C.R.S., of the Colorado Land Reclamation Act for the Extraction of <br /> Construction Materials. <br /> Applicant and Successor hereby request the State to consent to the assignment of the Permit Application to <br /> recognize the Successor as the Applicant under the permitting process. <br /> Black Mountain Sand DJ LLC Black Mountain Sand Weld LLC <br /> Name of Pe it Applicant Name of Successor Applicant <br /> By By IL <br /> Sign tur of Of i,-C Signatur of 61ficer <br /> PRE�-,r" Mk- � GAS <br /> Title of Officer Title of Officer <br /> NOTARY FOR PERMIT APPLICANT <br /> STATE OF ) <br /> COUNTY OF �� � ss. <br /> The foregoing instrument was acknowledged before me this day of , <br /> by L as &jF51 ClEnt of <br /> BRYANNA ARROYO LOCKHART OTARY PUBLI <br /> Notary ID#1 3 1 701 5 04 <br /> My Commission Expires <br /> August 28, 2022 My Commission expires: <br /> NOTARY FOR SUCCESSOR APPLICANT <br /> STATE OF �(� ) <br /> ss. <br /> COUNTY OF 2 ot ) <br /> The foregoing instrument was acknowledged before me this I I day of(-,un 6 Ot <br /> by �c)lc�� m► 1 Y l as /T \� of <br /> t BRYANNA ARROYO LOCKHART <br /> NotaryID#131701504 <br /> NO P��L:IC <br /> My Commission Expires <br /> August 28, 2022 '� <br /> \.tSt- 2`� 12�2 <br />