2011-11-14_REVISION - M2010062

• Permit No: M2010062
• IBM Index Class Name: REVISION
• Doc Date: 11/14/2011
• Doc Name: Transfer of Approved Appl. and SO Applicant
• From: White Sand & Gravel LLC
• To: DRMS
• Type & Sequence: SO2
• Email Name: SJR
• Email Name: TAK
• Email Name: SJM
• Media Type: D
• Archive: No

This form has been approved by the Mined Land Reclamation Board pursuant to sections 34 -32 -119, C.R.S., of the
Mined Land Reclamation Act and 34- 32.5 -119, C.R.S., of the Colorado Land Reclamation Act for the Extraction of
Construction Materials. Any alteration or modification of this form shall result in voiding any permit issued on the
altered or modified form and subject the operator to cease and desist orders and civil penalties for operating without a
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
Colorado Land. Reclamation Act for the Extraction of Construction Materials
Applicant and Successor hereby request the State to consent to the assignment of the approved Permit Application
to recognize the Successor as the approved Applicant under the permitting process.
Carder, Inc.
_ Name of Permit Applica
By
Signature of Officer
President
Title of Officer
STATE OF 6,)
) ss.
My Commission Expires 051172013
STATE OF
strurnent was acknowledged before me this y0day of , 41, by
as ?reS i GtE of
W(w s 4
) ss.
COUNTY OF T)1 e7 )
The foregoing instrument was acknowledged before me this
- it f)'l 1 frtlh as Manor
CARESSA D. JAYS
eigit Notary Public - State of Kansas
My Appt. Expires September 28. 2015
- 2 -
White Sand & Gravel LLC
Name of Successor Applicant
NOTARY FOR PERMIT APPLICANT
Signature of Officer
II? Z
/,1Q_4,)2&-
Title o Officer
NO RY PUBLIC / �
My Commission expires: /1-13
NOTARY FOR SUCCESSOR APPLICANT
e l day of NGl P, t hf,r , P-4/1, by
of W hf . sand 4- 6 Vane/
m
NOTA PUBLIC
My Commission expires:
N494)12,015--