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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 DC O L O o N oO <br /> Denver,Colorado 80203 RECLAMATION <br /> Phone:(303)866-3567 MINING <br /> FAX.(303)832-8106 SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information <br /> Permit Number: M2011-039 <br /> Operation Name: Colorado Moss Rock <br /> Permittee Information <br /> Contact Person: Kim Barickman <br /> Company Name: Colorado Moss Rock, Inc. <br /> Street Address: PO Box 51 <br /> City: Rye <br /> State: CO Zip: 81069 <br /> Phone: T19 ) 248-7333 <br /> Email (optional): <br /> Prospective Successor Information <br /> Contact Person: Nick Simpson <br /> Company Name: Premier Moss Rock, LLC <br /> Street Address: 5120 Windsor Avenue <br /> City: Edina <br /> State: MN Zip: 55436 <br /> Phone: (612 )237-2968 <br /> Email(optional): njsimpson01@gmail.com <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />