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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> C0LOECAD0 <br /> 1313 Sherman St,Room 215 [DIVISION OF i <br /> Denver,Colorado 80203 RECLAMATION <br /> Phone:(303)86"567 S o / MINING <br /> C t <br /> FAX:(303)t332-8106 y/ ( / SAFETY <br /> L <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> Y <br /> ADMINISTRATIVE INFORMATION RF-;E$,,LED <br /> Permit Information <br /> OEC 05 2016 <br /> M 2008-027 E)i"'i--- '�F• 4 <br /> Permit Number. 'Eciamation, <br /> K Safety <br /> Operation Name: Tepee Park Ranch Shale Borrow Pit <br /> Permittee Information <br /> Contact Person: <br /> Daniel Griffith <br /> Company Name: CPX I I Operating LLC <br /> Street Address: 420 Oil Center Drive <br /> city: Lafayette <br /> 4 <br /> State: LA Zip: 70503 <br /> Phone: �37 ) 984-4589 <br /> Email(optional): d, riffith cpxoil.com ✓ 4I 4�1 <br /> Prospective Successor Information ✓ "U �`�` ,, <br /> Contact Person: <br /> Ward Giltner <br /> Company Name: CPX Piceance Holdings LLC <br /> Street Address: <br /> 880 Wolverine CT <br /> t <br /> city: Castle Rock <br /> State: CO Zip: 80108 <br /> Phone: (303 )489-8773 [ <br /> Email(optional): wgiltner@yahoo.com <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br /> E <br />