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X11 �A(" <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 />rv-v 10 0( <br />STATE OF COLORADO <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />ADMINISTRATIVE INFORMATION <br />Permit Information <br />COLORADO <br />DIV IS I ON OF <br />RECLAMATION <br />MINING <br />SAFETY <br />RECEIVED <br />JUN 0 5 2015 <br />Permit Number: M <br />6 6 <br />/766 <br />— O L f D <br />Di i'miflkm 'Of ice, <br />intra .� y <br />Operation Name: q n <br />i3 � <br />i�7 <br />/T ly � <br />_5Cf,jj <br />Permittee Information <br />Contact Person: <br />Company Name: %3. 9w, <br />Street Address: _Z �z C. oZ1 4j©O(.� /Gfh� <br />City: <br />State: e�Lo✓0,6,gdo Zip: 2 L 2-0 <br />Phone: <br />Email (optional): 41,q ��Q �} 6- M q) ` . �U� <br />✓ -k2 <br />Prospective Successor Information ,� �(,(� P"yZl <br />Contact Person: t2 `TV���'�h r ,- 1i/a�1i� <br />Company Name: <br />Street Address: —1 <br />City: GA t vt4 <br />State: �e �' <br />Phone: ('I I; <br />Email (optional): <br />W <br />Rv <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and <br />Inactive Mines <br />II -1 —Telh, <br />0 <br />