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Rral6AM <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 />0 cola -CIW7 <br />STATE OF COLORADO <br />REC' 7 r� APPLICATION FORM <br />�- FOR TRANSFER OF MINERAL PERMIT AND <br />JAN 21 20115 5 SUCCESSION OF OPERATORS <br />DIVISION OF RECLAMATION <br />MININGAND SAFETY ADMINISTRATIVE INFORMATION <br />Permit Information <br />Permit Number: H, 2 Q/,2 —007 <br />Operation Name: (,f %Q 0,60-Are, Pl. <br />Permittee Information <br />Contact Person: 7-17 OM A' S <br />Company Name: III-C7 UU A^ �e !!F- Xrj Va <br />Street Address: <br />City: 5-o6,,7-- R ,k <br />State: C0 Zip: <br />Phone: ( 2 / C/ ) - ,? 19 - % 6 O -2- r- <br />Email (optional): O r -o U r f e e-.XG�q t/<IT% <br />Prospective Successor Information <br />COLORADO <br />D I V I S I ON OF <br />RECLAMATION <br />MINING <br />SAFETY <br />g 'rtti�` l l fContact Person: 61;e y�,y .2 L�F <br />Company Name: , � �,, f " / j � � �5� :Poe- <br />Street Address: <br />City: LQ/t% ©s, ✓ N <br />State: C 0 Zip: 9//0/ <br />Phone: ( �/9 ) 5y 91- 2- 163 <br />Email (optional): bjZ g 0 1j ,70 2 dj! Z_ <br />11 <br />Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango <br />Inactive Mines <br />V �j(,tl % 5liliq <br />Office of <br />Active and <br />