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OIDD NO <br /> STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY l <br /> Department of Natural Resources ) <br /> C01,L')£tA£)0 <br /> 1313 Sherman St.,Room 215 s i v i r s rs <br /> Denver,Colorado 80203 O�� l 7tt.f•.�.).J�MATIM <br /> Phone.(303)866-3567 M i IY ING <br /> FAX:(303)832-8106 ..�..,& � <br /> SA i•I•i`r' <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> RECEIVED <br /> ADMINISTRATIVE INFORMATION MAY 2 6 2017 <br /> Permit Information y <br /> Permit Number: H - z 0 o 0 ' j d <br /> Operation Name: rs �-� 41 7Fa,r rn K©cud r--a e + i <br /> Permittee Information--�- <br /> Contact Person: +�..1 U 5e--,P I,-) e !z S <br /> Company Name: <br /> Street Address: a 09 Ave iti-e- <br /> City: <br /> State: y y r a e 0 Zip: <br /> Phone: (� l � ) S So r, q <br /> Email(optional): <br /> Prospective Successor Information <br /> Contact Person: 1 �--) Cz r- A S S I <br /> Company Name: S r ��s�r�Z� To r'rn <br /> Street Address: oZ O �f yY'/7 �� / CiN R /.-v <br /> City: Pt_4 e"b ( U ,,, <br /> State: 6 i z)r(x.c4 L) Zip: ( U�`t �N D C//) C-t m'l� <br /> Phone: ( 7 1 c ) S ( ( — 80 S 7 <br /> Email(optional): r ri e, r _1 aa> rn i Chi S r r C' GC7 <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />