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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., of the <br />Mined Land Reclamation Act and 34-32.5-119, C.R.S., of the Colorado Land Reclamation Act for the Extraction of <br />Construction Materials. Any alteration or modification of this form shall result in voiding any permit issued on the <br />altered or modified form and subject 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 Reclamation Act and 34-32.5-123, C.R.S., of the <br />Colorado Land Reclamation Act for the Extraction 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 Permi App 'cant <br />By <br />Signature of Officer <br />?S/?rn?ar9 <br />Name of Successor Applicant <br />By <br />S' a ure of fficer <br />- re_,S eyx e, f <br />Title of Officer <br />Vl? e ?rc?,o/ar -/ <br />Title of Officer <br />NOTARY FOR PERMIT APPLICANT <br />STATE OF L -0 (..0 A--(JQ ) <br />ss. <br />COUNTY OF f j <br />The foregoing instrument was acknowledged before me this T day of ?a _QI D , by <br />1 asf <br />Of <br />ARY U IC LL <br />?, 0 .,•.... <br />My Commission expires; <br />// NOTARY FOR SUCCESSOR APPLICANT <br />STATE OF ro,& <br />) ss. srATE O? <br />COUNTY OF B5? ) l+ttt4tl` <br />The foregoing instrument was acknowledged b fore ?j? this oS if day of /"I l( IlS f o? n / o by <br />P?4ef 5 c??Ln? ?. '1 c of X"tt as ?? c SCy G?ot?j c? c <br />t I" <br />\1 P <br />P..• ........... <br />?i NOTARY PUBLIC <br />O N <br />tE?` r My expires: <br />Commission <br />r,?.t fEV = <br />.. O <br />OF C,0