2018-06-20_REVISION - M1974070

• Permit No: M1974070
• IBM Index Class Name: REVISION
• Doc Date: 6/20/2018
• Doc Name: Request For Succession Of Operator
• From: Aggregate Industries Management, Inc.
• To: DRMS
• Type & Sequence: SO4
• Email Name: PSH
• Email Name: MAC
• Media Type: D
• Archive: No

STATE OF COLORADO
DIVISION OF RECLAMATION, MINING AND SAFETY Ielei Department of Natural Resources iel)
1313 Sherman St.,Room 215 �U n p IV ISO L OI oN OF
DO
Denver,Colorado 80203 N "" t., .I;€4 RECLAMATION
Phone-[phone] MINING
FAX.[phone] � E('] �� SA&—
TY
APPLICATION FORM
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