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i <br />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 />56 <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />Permit Information <br />Permit Number: <br />ADMINISTRATIVE INFORMATION <br />,A— (9 c,-076 <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />RECEIVED <br />C <br />FEB 0 8 2016 <br />DIVISION OF RECLAMATION <br />MINING AND SAFETY <br />RECEIVED <br />DEC'g4 2015 <br />Division or Re <br />Operation Name: j, (' ANG+ j�l j ni MIr n� & $, <br />Permittee Information <br />Contact Person: Pot u J p Av" <br />Company Name: D �, M <br />Street Address: 1 z..s <br />City: F 4A, e v�. <br />State: N e, w elc 41 c, . Zip: ' 7 L 0 i <br />Phone: (.s'" 5 ) G 4 - 2 9 ( yep dii%) <br />Email (optional): <br />• <br />c/pi ontrPilk <br />pPr <br />124 dt;b <br />Prospective Successor Information <br />Contact Person: <br />Company Name: <br />✓cow°p fir' <br />r <br />kfcato <br />Street Address: 19, (07 CZ) fit PASS CI, Izi <br />City: 1)E. ( Mu 6 S <br />State: ` 3( Zip: j (02-0 <br />Phone: () 570 G7 3' <br />Email (optional): Yv1 eyoi L • ce <br />Office of <br />Mined Land Reclamation <br />Inactive Mines <br />Denver • Grand Junction • Durango <br />Office of <br />Active and <br />