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This form has been approved by the Mined Land Reclamation Board pursuant to sections 34 -32 -119, CR.S., of the <br />Mined Land Reclamation Act and 34- 325 -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, CR.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 Permit Applican" <br />13y <br />President <br />Title of Officer <br />STATE OF <br />Carder, Inc. <br />Signature of Officer <br />My Commission Expires 05/17/2013 <br />STATE OF 044/VS <br />NOTARY FOR PERMIT APPLICANT <br />strument was acknowledged before inc this �� day of <br />Pr S C:.tey \f <br />CARESSA D. JAYS <br />a Notary Public - State of Kansas <br />MyAppt. Expires September 28, 2015 <br />as <br />White Sand & Gravel LLC <br />Name of Successor Applicant <br />Signature of Officer <br />4-4-1 _AlQii.4.7-2A— <br />Title o Officer <br />L,£ <br />_, - . - / <br />NO' ARY PUBLIC <br />My Commission expires: -- <br />NOTARY FOR SUCCESSOR APPLICANT <br />NOTAI' PUBLIC <br />, by <br />of <br />) ss. <br />COUNTY OF mo ©N ) <br />The foregoing instrument was acknowledged before me this ey day of /uaU I ' - r . by <br />Tim Vfe as /4an 'r of 1A1 hi c. -3Cc 6. L-L <br />My Commission expires: /9.i/2JiI S <br />