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-2- <br />?h& form hat been approved by the Mined Land Reclamation Boardpnrsaantro sections 3431-119, C.R.S, ofthe <br />Mined Land Reclamation Actand 34-31.5-119, C.R.S, ofthe Colorado Land Reclamation ActfortheExtraction <br />ofConstraetionMaterialt. Any alterationarmodiJ:eadonojthisjorntshalltrsaltinvofdingatrypernrhissaedon <br />the altered or modified jorm sad sabJect tht operator ro cease and desbt orders and civil penalties for operating <br />without a peatnit patsaant ro sections 34-31-113, GR.S., of the Mined Land Reclamatoa Act and 34-31.5-113, <br />OR.S., of the Colorado Laad Reclamation Aet jor the Extraction of Consbuction Materials. <br />AppGe~nt and Sucxssor hereby inquest the State to consent to the assignment of the approved Permit <br />Application to reoogniu the Successor as the approved Applicant under the permitting process. <br />UldlG1t' S//f~/e5'kJ~re/~u~wo~)~C, db~ /CR2n15 ~o,e/T~T1 Co ,Jsy,¢ccc,Ti oeJ <br />(J-I~e~ I.OM[1ew~nf. OT ri S!~ e.r~-i, dGzA/[sL Lp~ <br />Name of Permit ppli t Name of Successor Applicant <br />sy -- - s ~ _ <br />Signs ire of fficer Signature of Officer <br />Prns~d~~` <br />Title of Officer <br />Title of Officer <br />~I~ ~n ®~ NOTARY FOR PERMIT APPLICANT <br />STATE OF 1,~'IN ~ Qom/ ) <br />ss. <br />COUNTY OF `~ ) <br />was acknowledged before the this ~ day of <br />My Coa®ssion <br />/ /NOTARY FOR SUCCESSOR APPLICANT <br />STATE OP ~~~( ~/l~-GC-k/ ) <br />ss. <br />COUNTY OF y-~ <br />f~~'~,e f going was acktowledged ore me this ~ "`day of _ <br />P ,:.... <br />J '~ r ~' <br />~~ ~Aa~ <br />.- <br />~of <br />.: ~~ - <br />~ 1~1~. <br />My Commission expires: <br />~//Oj <br />~~~ ~ <br />ry-~.' . ~ ... <br />.-'T':' r <br />.n _ <br />J~/ ~~~ <br />