2012-10-22_REVISION - M2002120

• Permit No: M2002120
• IBM Index Class Name: REVISION
• Doc Date: 10/22/2012
• Doc Name: SO-01 APPROVAL
• From: DRMS
• To: BESTWAY CONCRETE COMPANY
• Type & Sequence: SO1
• Email Name: ECS
• Email Name: TAK
• 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, C.R.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.
A L,uk,;aa -,t1CD
-1-12-40 ;
Name of Permit Applicant
By
Czanpa
Name of Succe sor Applicant
By
Signature of Officer Signature of Officer
STATE OF
Title of Officer
/2/"`44
COUNTY OF ///r/ /�
1� � ire/
, -Z w/ i L"o e l OoPQ7 b7
STATE OF /'Q )
ss.
COUNTY OF �/ )
NOTARY FOR PERMIT APPLICANT
)
) ss
)
The foregoing instrument was acknowledged before me this R. day of
...... ..•�N�`
'• INloTAR • r
V..
NOTARY FOR SUCCESSOR APPLICANT
/� The foregoing instrument was acknowledged before me this )0 day of i,/ �t ( �/ , ? 442 , by
d ewe G 4l 7 pces/e?f of �f �ir�ll� 6.7e/e _inc.
2/eL
NOTARY PUBLIC
c)...-
i +t c.
- 2 -
Title of Officer
NOTARY PUBLIC
My Commission expires: 4 /i
4I'
, pZV,2,
of
My Commission expires: 4ri/