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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 Icy&V4-W <br />STATE OF COLORADO <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />ADMINISTRATIVE INFORMATION <br />COLORADO <br />D IVI SION OF <br />RECLAMATION <br />MINING <br />— <br />SAFETY <br />RECEIVED <br />'JUN 19 Z0f5, <br />Permit Information Vix Ww(0fPw61"6w, <br />Permit Number: hh 11 <br />Operation Name: V Cho/ — C l &ACLUI: PI <br />Permittee Information <br />Cont, <br />Coral <br />Street <br />City: <br />State: on <br />W Zip: <br />Phone: (2%0 ) 30 - I R 17 <br />Email (optional): <br />Prospective Successor Information <br />Contact Person: <br />Company Name: 9*4- V-EAa •..XzM�L q-C,AaLf-( td -C, <br />Street Address: JLe757 CK/6 Nd Wl- <br />City: A occ& <br />State: ro/a-ado Zip: '?JO -7 a n <br />Phone: ( 970 ) <br />Email (optional): v -e ffe r i e usclE e C*Q . 11,#hvU,'Con1 <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and <br />Inactive Mines <br />