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oc- <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 />STATE OF COLORADO <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />ADMINISTRATIVE INFORMATION <br />Permit Information <br />Permit Number: <br />Operation Name:. 1120,C '�� y� <br />Permittee Information ��— <br />Contact Person: <br />Company Name )u -�G <br />Street Address: I x Q 7 O nu n 1 0 1X0 <br />City: S ►i�q <br />State: 0lp Zip: I 12L r <br />Phone: ("7 `r ) �.7`� ` 2 q 3(2) <br />Email (optional): <br />Prospective Successor Information <br />Contact Person: 6-�e'4a -.1 ,p/�l�,M�-�Z, <br />Company Name: 6b- ?P-a& i' ' l it) I i16 U� <br />Street Address: <br />City: <br />State: Zip: <br />Phone: _(:21 q ) 0 Ll &6'7 <br />Email (optional): <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br /><5;E)02� <br />RECEIVED <br />FEB 0 5 2014 <br />Division of Reclamation, <br />— Mining & Safety <br />Office of ' Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango j_✓ ctiv a <br />Inactive Mines 1x1-1v- jgq_5-c( (-j- �tr t'� <br />