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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 />STATE OF COLORADO <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />ADMINISTRATIVE INFORMATION <br />Permit Information <br />Permit Number: 41 - ,2 O / p - p 3 * <br />Operation Name: DC ,EjVn,4 FF ,;= g <br />Permittee Information <br />Contact Person: B O A W j 4 L/ r,5 <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />Company Name: Vl/1LL >T5 AI C <br />Street Address: P 0. 8 0 X R2 <br />city: CH4 YE RECEIVED <br />State: —IAJ Y Zip: .�. 0,0-4 -r7nlD CV nvpL .lam <br />Phone: ( 307 ) 6 3 4 - .2 .30 0 'JUN 19 231 <br />Email (optional): Orvrsion of REoIwpmj"; <br />ming & Sa(o y <br />Prospective Successor Information <br />Contact Person: R / CX IW 14- 4 j6.,R <br />Company Name: S Y& y e/YZ-RPR 1,7 r -S ,� c <br />Street Address: P.O. Box z3 gEELF y <br />City: E L g y <br />State: GO Zip: f9 w L U P I Vjo <br />Phone: <br />Email (optional): <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and <br />Inactive Mines <br />