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F <br />V- 1,c <br />STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832-8106 <br />Soo/ N(1 a�5'iv5 <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />L7/ APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />J RECEIVED <br />ADMINISTRATIVE INFORMATION , J0 <br />Prospective Successor Information <br />Contact Person: y y 11W (� 'e e <br />Company Name:.; <br />Street Address: a p /t''� �, ;� ',S', <br />City :y <br />State: C: 10/ Y /Z d a Zip: / e7 f-2— <br />Phone: zff. y <br />Email (optional): <br />/Zhe <br />W&I, <br />Office of <br />Office of <br />Mined Land Reclamation - Denver • Grand Junction • Durango Active and <br />Inactive Mines <br />DIVISION OP RECLAMATION <br />Permit Information <br />�� MINING AND SAFETY <br />Permit Number: N(- (� 5 — V5 <br />ii�� O <br />Operation Name: W 1 A-N C44 <br />p 1 r <br />Permittee Information <br />Contact Person: A a T W) N r r,--& <br />dlJ <br />Company Name: Hal'" L-6 A WW <br />Street Address: 2 01 6 G ►2 -7 5 •D <br />City: L ki N 16 kp <br />State: GO Zip: <br />010 e2. <br />Phone: ( 7141 1t t?2 q' . <br />Email (optional): <br />Prospective Successor Information <br />Contact Person: y y 11W (� 'e e <br />Company Name:.; <br />Street Address: a p /t''� �, ;� ',S', <br />City :y <br />State: C: 10/ Y /Z d a Zip: / e7 f-2— <br />Phone: zff. y <br />Email (optional): <br />/Zhe <br />W&I, <br />Office of <br />Office of <br />Mined Land Reclamation - Denver • Grand Junction • Durango Active and <br />Inactive Mines <br />