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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 Material& 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 />4/a?uy?f? OIL" <br />t (? Cnw,Pr,,.v„t <br />G?t7LC`? % \ c r cl Si ,i?c?l of Alesal <br />Name of Permit Applicant Name of Successor App icant ??'" K <br />By By "- J <br />Signature of Officer ignature o Officer <br />-Pr65 Cd Xc c f <br />Title of Officer Title of Officer <br />NOTARY FOR PERMIT APPLICANT <br />STATE OF LX)-LVKAT->0 ) <br />i ) js. <br />COUNTY OF The fore ping instrument was acknowledged before me this day of AaLkG7r <br />. ?1? • by <br />as - CC-> l D?1T of <br />LM ZL I <br />L 40AR?Y;?V-11C/ My Commission expires: ?'? - •.. <br />Q ••'L <br />NOTARY FOR SUCCESSOR APPLICANT = xm `'O p <br />_ Q <br />:;Z V <br />STATE OF l 0 11D lQ ) ?' 0 <br />) ss. pJ ; GO <br />COUNTY OF STASEOX•`?` <br />he foregoing instrument was acknowledged b fore rr?e this day of 5f o7:? 1 d . by <br />1A uAd as e ?desA of Duj:!Q:5?IQ SU) 60/0c.4,iiC .016- G S <br />?fer ?" <br />e5al°C "A of <br />S AR Y pG NOTARY PUBLIC CJ-16-/o <br />% <br />r MAN?le `C' <br />CFCH E <br />0 <br />OF COlORPO <br />My Commission expires: l oC D I