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w,, vc l (;19 I <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 />SO Z COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />ADMINISTRATIVE INFORMATION <br />Permit Information <br />Permit Number: 4 - i 19 / - / 33 <br />Operation Name: G/% L D C 2- VC- MIA) 6� <br />Permittee Information <br />Contact Person: Qj5MC- -'RIO VA L Ot7 -Z <br />Company Name: L L, rZ7 5C 0A1,Q /".Y?0 R14NG 14 <br />Street Address: /© e , /✓ D)( 8' �- <br />City: Coly/ FJ oS RECEIVED <br />State: GO Zip: <br />Phone: ( ) JUL 1 1 2014 <br />Division of ire ,lamatio% <br />Email (optional): Min ?ng & Safety <br />Prospective Successor Information <br />Contact Person: /rW1VZ?y / '91,4/8 ,3c, <br />Company Name: /fO,QiAI S lO/C)-S %7ZCJG7' / D // ­4e97_ _ 2 Z L %� <br />Street Address: /� a, &0 k --'-7 /_:� <br />City: /IVIi01U / 7-0 <br />State: C-0 Zip: F112— O <br />Phone: ( J19 ) 3 76 ?" <br />Email (optional): <br />Office of <br />Mined Land Reclamation <br />Inactive Mines <br />A/ O 1/ _ /\/Ox'1 e <br />1r y/,7p <br />Denver • Grand 'Junction • Durango <br />Office of <br />Active and <br />