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iA <br />DIVISION OF RECLAMATION, MINING AND SAFETY STATE OF COLORADO <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203. C o LORAD ❑ <br />Phone: (303) 866-3567 o—D r VESiOM of <br />FAX: (303) 832-8166 RELT <br />IQN <br />MINING <br />5AFE7'Y <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />ADMINISTRATIVE I%nvO ON RECEI <br />I <br />Permit Information JAN 2 2 2019 <br />Permit Number: M-1995-095 DIVISD I40FFII;Cl."'>" <br />Operation Name: Slmla H y P!t MIMANDSAfi"3y <br />Permittee Information <br />Contact Person: James Shelton <br />Company Name: <br />Street Address: 19855 Chelton Rd <br />city: Ramah <br />State: V U <br />Phone: <br />Email- (optional): <br />Prospective Successor Information <br />Contact Person: Blake Tope <br />Company Name: 4A; <br />Street Address: 21225 Scatt Rd <br />city: Calhan <br />State: CO <br />zip: 80832 <br />LLC- <br />Phone: 1 g 313-7728 <br />Email (optional): <br />V nice or <br />Mined Land Reclamation <br />Inactive {dines <br />Denver • Grand Junction • Durango <br />Office of <br />AeUvve and <br />Phi <br />