2018-06-18_REVISION - M1991035

• Permit No: M1991035
• IBM Index Class Name: REVISION
• Doc Date: 6/18/2018
• Doc Name: Request For Succession Of Operator
• From: LaFarge West, Inc.
• To: DRMS
• Type & Sequence: SO4
• Email Name: ECS
• Email Name: MAC
• Media Type: D
• Archive: No

STATE OF COLORADO
DIVISION OF RECLAMATION, MINING AND SAFETY Q
Department of Natural Resources • ECEIVED C O L O RA D O
1313 Sherman St.,Room 215
�j p IV IS l ON OF
Denver,Colorado 80203 JUN 1 U �'� RECLAMATION
Phone [phone]
FAX:[phone] VWWON OF Rm SAFETY
APPLICATION FORM
�fNOArvD saF �°N
FOR TRANSFER OF MINERAL PERMIT AND
SUCCESSION OF OPERATORS
ADMINISTRATIVE INFORMATION
Permit Information
Permit Number:
Operation Name:
Permittee Information
Contact Person:
Company Name:
Street Address:
City:
State: Zip:
Phone: ( )
Email (optional):
Prospective Successor Information
Contact Person:
Company Name:
Street Address:
City:
State: Zip:
Phone: ( )
Email (optional):
Office of Office of
Mined Land Reclamation Denver•Grand Junction•Durango Active and
Inactive Mines