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l vox- STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY Ma 5 v3�-- <br />Department of Natural Resources <br />1313 Sherman St., Room 215 D O L RA D O <br />D I V I E S I ON OF <br />Denver, Colorado 80203 RECLAMATION <br />Phone: (303) 866 -3567 MINING <br />FAX: (303) 832 -8106 —&— <br />SAF ETY <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />ADMINISTRATIVE INFORMATION <br />RECEIVED <br />Permit Information <br />Permit Number: <br />ON-19I CT RECLAMATI <br />Operation Name: ( V I( Q, )Q /-& MINING AND SAFETY <br />Permittee Ini�rma ion <br />Contact Person: -,.)e "�(�q l� e <br />Company Name: Sod(, c,G'& s sQ / <br />Caw <br />I n L <br />Street Address: 55 /leq Cb lZJ ZZ <br />City: Lj L&Ma <br />State: Cy Zip: S()75 lr <br />Phone:-070 095 <br />Email (optional): tiC rairrtS 17�?ff C--�' yctwo• cow <br />Prospective Successor Information <br />Contact Person: j e �p Soy a-qt'e— <br />Company Name: J C 'Fa- r rrS I n c <br />Street Address: S -5-/,'6 q (f e.> Qd ZZ <br />City: L4 LA al Q <br />State: v'/U Zip: 3U7�j <br />Phone: (9?0 ) (P30' 0855 <br />Email (optional): Y't tivy, corri <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and <br />Inactive Mines <br />