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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 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />Permit Information <br />Permit Number: <br />Operation Name: <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />-&- <br />SAFETY <br />RECEIVED <br />ADMINISTRATIVE INFORMATION T✓UG9cod t-&-- <br />DEC 0 4 2015 <br />Division of Reclamation, <br />Mining & Safety <br />N11983--/03 <br />E ACT DQU GL P/7 <br />Permittee Information <br />Contact Person: <br />Company Name: <br />Sbsc-p/+ I/6_/v)T <br />TR) 6 - <br />Street Address: /mob go - / / Z <br />City: CL/ <br />State: W Zip: 0/618 <br />8 <br />Phone: RID ) 6 :5- — De -7S3 4- 35 (G 3Z - 502-6i <br />IRs ND. F ,14 41-41,0 Pk <br />$ 0(4/at_ UT j <br />Email (optional): -5 d 1 L ® ,VET UT -4 4 <br />Prospective Successor Information Voca Ai /J -6 <br />Contact Person: ,4L4AJ P eE1Z S p t ) <br />N 6N <br />Company Name: P/�-ro 6&) Coo S7 /( 7'/ p,k) (A1(� MI✓t,VA/i41 <br />Street Address: 7/ Q SO c /7-4 / 4'L <br />City: G=amkJ5y:_ j <br />/ (AI t"1 <br />State: liu Zip: g (c <br />-7— <br />Phone: (QlO ) 2 81 39 <br />Email (optional): ( ,1JJ ® p' i C.S C)u$ , CA AA <br />Office of <br />Mined Land Redamation <br />Inactive Mines <br />Denver • Grand Junction • Durango <br />Office of <br />Active and <br />