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-2- <br />This form has been approved by the Mined Latid Reclamation Board pursuant to sections 34-32119, .R'S., of the <br />Mined Land Reclamation Act and 34-32.5-119, C.R.S., of f to Colorado Land Reclamation Act for the Extraction of <br />Construction Materials. Any alteration or modification of this forrn shall result in voiding any ,permit issued on the <br />altered or modffred form and subject the operator to cease and desist orders and civil penalties for operating without a <br />permit pursuant to secdons 34-32-123, C.RS., of the Mined Land Reclamation Act and 34-32.5-123, C.I.S., of the <br />Colorado Land Reehimadan Act for the Extraction of Construction Materialk <br />Applicant and Successor hereby request the State to consent to the assignment of the approved Permit Application to <br />recognize the Successor as the approved Applicant lmdet the permitting process. <br />©yll ???evrces Inc, <br />Name of Successor Applicant <br />By. e <br />Signature ofOfhicer <br />STATE OF <br />COUNTY OF <br />foregoing instrument was <br />P vies id erL T <br />Title of Officer <br />NOTA 2 Y FOR PERIVIIT APPLICANT ' <br />ss. <br />M efora mc_ day of f?V? (?G?'tl ` ,1? vva fly <br />.?, el _ a > <br />NOTARY <br />9??-pF CO--' NOTARY K BLIC -- <br />fly Commission Expires Dec 07 2008 <br />vly Commission expires: - <br />STATs OF <br />COL-.N"I-Y Or <br />`I'he foregloin 'Instrument was acknowledged before me this S1- day of. by <br />as of Cwne- QO w_-r P E <br />o.? ... ........(41 <br />SUMMER M'? <br />. JONES ' • -tiC}'I'AR?' 1'I.t3L.EC <br />iLy Commission expires: <br />MY COMMISSION EXPIRES: <br />3, 2011 <br />300/ 300'd 988£# Z6Z££ZZOL6 Z0:11 900Z'L0'130 <br />/ / C4A-.,' <br />Title of Officer