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f STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 C O L O RA D O <br /> DIVISION O F <br /> Denver,Colorado 3567 ,j3 ` rn n RECLAMATION <br /> Phone:(303)866-3567 /� /'7(�i /�f(�(/ MINING <br /> FAX:(303)832-8106 V —&— <br /> SAF ETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information <br /> Permit Number: M-2008-078 <br /> RECEIVED <br /> Operation Name: West Farm Pit <br /> Permittee Information JUN 3 0 2016 <br /> Contact Person: Jay Nielson [3iVisM Or��, � <br /> Company Name: Aggregate Services LLC & '' <br /> Street Address: 820 Airport Road <br /> city: Durango <br /> State: Colorado Zip: 81303 <br /> � l 12L <br /> Phone:_( ) 970-884-4869 <br /> ✓ � �� r-r' n'L J <br /> Email (optional): jay.nielsonCa-)crossfire-Ilc.com b� LLAZL- 6n ,5/Z1-/il, <br /> cam. Al I -I I t-7 <br /> Prospective Successor Information ✓ <br /> Contact Person: K f*n."- /y Qy Sf <br /> Company Name: P,o� <br /> Street Address: 2 q 1 ( rL +r—ld w�+`4' SV tTC Z-0 0 <br /> City: L t f-r C— 7-0..1 <br /> State: Zip: g 0/z7 <br /> Phone: ( 3y3 ) 3 to 41 — S t o 0 <br /> Email (optional): /G/A-kt L �J C ,¢ `n t t p,4,ut e,S Ca44 <br /> Office of Office of <br /> Mined Land Reclamation Denver-Grand Junction-Durango Active and <br /> Inactive Mines <br />