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This farm hos been approved by the Mined Lund Reclamation Board pursuant to sections 34 -32 -119, C.R.S., <br />of the Mined Land Reclamation Act and 34 -32.5 -119, C.R.S., of the Colorado Land Reclamation Act for the <br />Extraction of Construction Materials. Any alteration or modification of this form shall res alt in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil <br />penalties for operating without a permit pursuant to sections 34 -32 -123, C.R.S., of the Mined Land <br />Reclamation Act and 34 -32.5 -123, GR.S, of the Colorado Land Reclamation Act for the Extraction of <br />Construction Materials. <br />Applicant and Successor hereby request the State to consent to the assignment of the Permit Application to <br />recognize the Successor as the Applicant under the permitting process. <br />Weeminuche Construction Authority <br />Name of Pc <br />13) <br />SIAIEOI <br />Sign turc of Officer <br />General Manager <br />I itle of Officer <br />COL N1Y01. <br />I'hc foregoing instrument was acknowledged before me this ` 3 da of � Q( J i,, be( <br />b� <br />-Tart - -- _ -- __ -- as i-ene rzt rt /An,r <br />11 G✓16 <br />WENDY NARANJO <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />Reston xplres <br />by ko la. (Yl. lrttQI -‘ <br />NOTARY FOR PERMIT APPLICANT <br />) ss. <br />rrat-r2ul-1n&4 <br />SIA'l COrriio ) <br />) ss. <br />COUNIYOI' Li P%Qk0.. ) <br />- 2 - <br />Oldcastle SW Group, Inc dba FOUR CORNERS MATERIALS <br />Name of Successor Applicant <br />B> r 17 <br />Sign ure of Officer <br />General Manager <br />- title of Officer <br />NO A <br />My Commission expires:] / <br />NOTARY FOR SUCCESSOR FOR SUCCESSOR APPLICANT 777___ <br />fhe foregoing instrument was acknowledged before me this _ day of OCICADtr .a131 l . <br />daoa- FourCorr%4s riu..ls• <br />NO I ARY I't BLIC <br />a" L' _I . t! iII _a . -24 <br />I <br />e I � i <br />OF r_ O' <br />Myccmmisswl a A 1 . as 09,16/2015 <br />