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<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, CRS., 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.RS, 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 />White Sand & Gravel LLC <br />Name of Permit Applicant <br />Signature of Oficer <br />mamma 2A <br />Title of Officer <br />Carder Inc <br />Name of Successor Applicant <br />BY ' .G0' <br />Signature of Officer <br />Title of Officer <br />• NOTARY FOR PERMIT APPLICANT <br />STATE OF <br />ss. <br />COUNTY OF YY?6?ty? <br />The foregoing instrument was acknowledge <br />??1?,?,1 ?? • I? as <br />3, L? c. <br />NOTARY PUBLI <br />My Commission expires: 6 zf <br />NOTARY FOR SUCCESSOR APPLICANT r <br />STATE OF <br />Ug"14- <br />)ss. <br />COUNTY OF ??It ?,tF'iUli ) <br /> <br />• <br />• <br />s? •. Av B?\ C) .? ?° <br />q?F OF CG v <br />d before me this « day of A00 by <br />7'11 Ct-v? of <br />I/10 <br />;ed before me this day of <br />'VX <br />M?•I <br />as fvllu of <br />N ARY PUBLIC <br />My Commission expires: _ q-- /I- -/ 3 <br />My Commission Expires V1719 013