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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 D O L O o AN of <br />Denver, Colorado 80203 RECLAMATION <br />Phone: (303) 866-3567O MI SING <br />:5 a <br />FAX: (303) 832-8106 <br />SAFETY <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />RECEIVED <br />ADMINISTRATIVE INFORMATION <br />IPPR 0 2 2015 <br />Permit Information Division of Reclamation, <br />Mining & SafAy <br />Permit Number: {'��% - �� - /U �2, / -ltt� Pit <br />Operation Name: ��� >12 C r f -2l< �) f-tc <t� R 12Q IS <br />Permittee Information <br />Contact Person: i� �1� ��� L��� e i/ x%201.5 <br />Company Name: {� - M /U %-AJ of (?0M0 f} W -'j <br />Street Address: ,9'7 7 J4 5 GLi �-` ' pd <br />city: Na-.cl/ - <br />State: (�(J. Zip:'l a� <br />Phone: ( V-26 964 - 7 5 / 31 <br />Email (optional): VOOY`Y)1 i kP ® 4 0 L, CU✓i <br />Prospective Successor Information <br />Contact Person: 'OG} N C &- uI N S /Ac Ne�1el f,/a i4 " 2 <br />Company Name: (f, �C) LCA! N 5 t" I2f726 L_L- C <br />Street Address: <br />City: <-vLAAk, <br />State: ,'� Zip:�j <br />Phone: (�g(�) is zz ;�� .i 01,All TIt <br />Email (optional): Ul (:�x f1 c i -vi S .5 (A C1 <br />Office of Office of <br />—� Mined Land Reclamation Denver • Grand Junction • Durango Active and <br />Inactive Mines <br />