REV84100

• Permit No: M1976007UG
• IBM Index Class Name: Revision
• Doc Date: 5/19/1997
• Doc Name: TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO1
• Media Type: D
• Archive: No

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ra~~F COLORADO _ _
MINED LAND RECLAMATION DIVISION of Coro
Department of Nalurai Resources ti`v~~~
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1313 Sherman St., Roam 275 `,
Denver. CO 60203 ~ ~-/ L_ I ~/
303 8fi6-3567 'ra 75'•
RA X: 303 632-6706 _
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TRANSFER OF PERMIT AND SUCCESSION ~6I$'RA'f0R5~~ •_
APPLICATION FORM
The application for a Transfer of Permit and Succession of Operators mu~;t contain three
(3) major parts: 1> an Application Form; 2) a Performance Warranty (ati:ached as part of
the Application Package) bearing the original notarized signature of they Successor
Operator; and, 3) a replacement Financial Warranty (for the amount maintained by the
current permittee) provided by the Successor Operator, bearing an origir~al notarized
signature. To expedite processing, please provide the information in the format and
order described below. 7
h.lt_r ~' _; r
I. ADMINISTRATIVE INFORMATION
1. Permit Number:
2. Operation Name:
76-7 - l~6
The Golden Mine
3. Current Permitted ODerator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. $UCCeSSDY ODerdtor:
Don Looper
DFC Ceramics. Inc.
515 S 19th St., PO Box 110
Canon City, CO
Zip Code: a121z
719 Telephone: [phone]
Denver Brick Comoanv
401 N Santa Fe Rd., PO Box 1600
Castle Rock, CO
Area Code: 303 Telephone: [phone]
IRS Tax ID No. or Social Security No.:
Contact Person:
Company Name:
Street:
City:
State:
Wayne Spence
Zip Code: 80104
5. Application Fee: $100.00