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0 <br /> <br />This farm has been approver/ b ' v the Mined Land Reclamation Board pursuant to sections 34-32-1 /9, C.R.S., of the <br />Mined Land Reclamation Act and 34-31.5-119, C.R.S., of the Colorado Lund Reclamation Act fur the Extraction of <br />Construction ,lfalc•rials. An alteration or modification of Ihis form shall result in voiding an?' permit issued on the <br />altered or modified form and suhjec•t the operator to cease and desist orders and civil penalties for operating without a <br />permit pursuant to sections 34-32-123, C.R.S., of the Mined Land Rec•lumation Ac•t and 34-32.5-123, C.R..S., of the <br />Colorado Land Reclamation Act for the E.rlraction of Construction Materials. <br />Applicant and Successor hereby request the State to consent to the assignment of the approved Permit Application <br />to recognize the Successor as the approved Applicant under the permitting process. <br />Name of Permit Applicant Name of Successor Applicant <br />R J? \ - T <br />y By Signature of'Officer Signature of Office <br />Fitle of Officer Title of Officer <br />NOTARY FOR PFRMIT APPLICANT <br />STATE OF CCAC)f Qk(\ ' ) <br />) SS. <br />COUNTY OF ?`\u?1?1 L?•r??C> ) <br />The foregoing instrument was acknowledged before me this ? day of Sl-;LQ? <br />\U \S- as I_L(-16 <br />? /• ? 1 .1 <br />NOTA Y P LIC t <br />My Commission expires: <br />NOTARY FOR SUCCESSOR APPLICANT <br />STATF OF <br />) ss. <br />COUNTY OF VV\oi \ ?- ? [ ?,,r t \G ) <br />The foregoing instrument was acknowledged before me this day of J v.v\ ? s1, Lt ??1, by <br />??11\ .?\uI 4 as 111l? I??,jk ?' of 1?3 [i PLC tkA rlA C' La ck 0 <br />i l V il/ •+. <br />(J A-V <br />NOT;A Y P LiC <br />My Commission expires: <br />y