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� pk <br /> STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY RECEIVED <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 APR 2 7 2016 COLORADO <br /> DIVISION OF <br /> Denver,Colorado 80203 G RECLAMATION <br /> Phone:(303)866-3567 � MINING <br /> FAX:(303)832-8106 ONIONOF REcumATION —& <br /> KiM sAFEFY SAFETY <br /> G4 APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information <br /> Permit Number: ►-' - 1 °( 0 3- 0 3 0 <br /> Operation Name: G ` • - - - Ger-ft-6a Ga- I "La- <br /> Permittee Information <br /> Contact Person: r--ft:2S104 L l 6 4/ S <br /> Company Name: Cl/14/z, 37....4 ./L-4.7% L L C_ <br /> Street Address: Z") z© ePcif4 #4 (- <br /> City: � 6,2r Sp;:yeS <br /> State: Co Zip: fa 90 / <br /> / <br /> Phone: (7/) ) ' 5 Y ” <br /> Email (optional): OP ;rings S /oe ,,/ !f 66614-4' <br /> AliA <br /> Prospective Successor Information 312-4 of <br /> Contact Person: P1, L , �&-ry,S ✓ 110 -/K -11r11- <br /> Company <br /> ' 'Company Name: C s7`.0 Q , e. ,o puv✓yt'�csf?) t/ /,U' t lq° <br /> Street Address: E 9 Zo Cecla-'• yf5 )/' <br /> City: &/54--Ad 5ior,h1 S <br /> State: CO Zip: gD q O V <br /> Phone: (7/q ) /5 1//7 <br /> Email (optional): LU f (�rn/;/ cor) e-eziot <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />