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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, <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 /> IHC Scott, Inc. WW Clyde & Company <br /> Name of Permit Applica Name of Successor Applicant <br /> By By <br /> Signa re f Officer SigLyn <br /> f icer <br /> Area Manager, Aggregates Are nager Aggregates <br /> Title of Officer Title of Officer <br /> NOTARY FOR PERMIT APPLICANT <br /> STATE OF( <br /> ss. <br /> COUNTY OF -)J4 <br /> ) <br /> Thy foregoing instrument was acknowledged before me this day ofz , <br /> by , as of <br /> J-7 <br /> Peggy L Sherman Af <br /> NOTARY PUBLIC OT LIC <br /> STATE OF COLORADO <br /> NOTARY C 200440114-84 My Commission expires: <br /> MY COMMISSION EXP1RES December 30.2023 <br /> NOTARY FOR SUCCESSOR APPLICANT <br /> STATE O U >!~ ) <br /> n ) ss. <br /> COUNTY OFJ ) <br /> Thp foregoing instrument was acknowledged before me this/L2� y of <br /> by as of <br /> Peggy L Sherman <br /> NOTARY PUBLIC NOTAR LI <br /> STATE OF COLORADO <br /> NOTARY 10 20044011454 <br /> ,4Y COMA41SS.4N EXPIRES December 3O.2023 <br />