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9 -2- <br />This form has been approved by the Mined Land Reclamation Board pursuant to sections 34-32-119, C.R.&, 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.&, of the <br />Colorado Land Reclamation Actfor 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 />White Sand & Gravel LLC <br />Name of Permit Applicant <br />.?*c D <br />Signature of Officer <br />m <br />Title of Officer <br />Carder Inc <br />Name of Successor Applicant <br />B <br />Y <br />Signature of Officer <br />Title of Officer <br />• NOTARY FOR PERMIT APPLICANT <br />STATE OF <br />ss. <br />COUNTY OF 1'j'I?;.rv?J ) <br />The foregoing instrument was acknowledged before me this // day of , a00 ( by <br />.t?vv u l ?? VJ 1 - as 'Y)1 c- -t. of <br />l„S? . Sc-?L 3, L L Cr <br />NOTARY PUBLI <br />My Commission expires: 6 z j <br />NOTARY FOR SUCCESSOR APPLICANT <br />STATE OF OJmA 1 <br />ss. <br />COUNTY OF Lutw--- ) <br /> <br />tr?q ., ,ov B??U .Pao <br />TF CF CG?G <br />,ed be ore me this / h day of <br />as of 0'lkt? J'a'r?' <br />N ARY PUBLIC 4 <br />My Commission expires: -5-- /1-- f 3 <br />My Commission Expires V, 719013