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4,"c -aa7qi ivl I "'T& I 2 <br /> STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY RECEIVED <br /> Department of Natural Resources <br /> 1313 Sherman St,Room 215 AUG 2 3 2017 D CO I S L E R A D ION OF <br /> DIV <br /> Denver,Colorado 80203 RECLAMATION <br /> Phone-(303)866-3567 50-1 MINING <br /> FAX:(303)832-8106 DIVISION OF RECLAMATION —&— <br /> MINING AND SAFETY SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information <br /> Permit Number: - H O <br /> Operation Name: <br /> Permittee Information (I <br /> Contact Person: ] <br /> Company Name: (�UYVI 1yI <br /> Street Address: h d <br /> City: LIVIC <br /> State: Zip: of-03 I t OCi <br /> _ J � <br /> Phone: ( 3� ) `1 1 la ' H 5 rt4i a Sul <br /> �✓ ��t1���- PvJS� <br /> Email(optional): �/ '� d� I gA C, a-vtnl <br /> -k f IYV�VA fwpolrk- <br /> pc -'-w-0 <br /> Prospective Successor Information ', -7-3r1-►"1 <br /> Contact Person: R(Atj <br /> Company Name: v dl � <br /> Street Address: q) <br /> City: tJ.n e tM G�t <br /> State (01pk`c4 AU Zip: <br /> Phone: <br /> Email (optional): �` }� A�m C Cr M CA , 1. Ca r ) <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />